Onyx胶栓塞治疗脑动静脉畸形的临床应用.doc

Onyx胶栓塞治疗脑动静脉畸形的临床应用【摘要】? 目的 总结新型液态栓塞剂Onyx栓塞脑动静脉畸形21例的技术要点和临床疗效。方法 Onyx栓塞脑动静脉畸形21例，均采用Seldinger技术在股动脉内置入6F鞘,6F导引导管进入颈内动脉或椎动脉, Ultraflow、Marathon或Rebar微导管超选择进入畸形血管团内,采用“注胶-返流-停止-再注胶”技术长时间缓慢注射Onyx栓塞脑动静脉畸形。结果 栓塞前后脑动静脉畸形闭塞30%～50% 7例，50%～80% 8例，80%以上6例。10例患者术后辅以伽玛刀治疗，其中2例一年以后复查DSA显示AVM完全闭塞。结论Onyx可提高脑动静脉畸形的栓塞效果,但应正确采用栓塞技术和注意预防并发症，长期疗效需要进一步随访。 【关键词】? 脑动静脉畸形 血管内治疗Clinical application in the embolization of cerebral arteriovenous malformation with onyx ZHAO Peng lai, MA Jun, HUANG Qing jiu, et al. Department of Neurosurgery, Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China  ??Abstract: Objective To summarize the embolization techniques and efficacy of cerebral arteriovenous malformation(CAVM) with a new liquid embolic agent(Onyx). Methods 6F sheath was inserted into femoral artery followed by 6F guiding catheter introduced into the internal carotid artery or vertebral artery, Ultraflow or Marathon micro catheter could be navigated into the nidus of AVMs, then the Onyx was injected slowly into the cerebral AVM with the“inject back flow stop reinject” technique. Results 30%～50% embolization were achieved in 7 cases, 50%～80% in 8 cases, more than 80% in 6 cases. 10 cases were treated by γ knife after embolization. 2 cases showed complete occlusion after radiosurgery. Conclusions Onyx has unique and distinctive superiority in treating cerebral AVMs. However, the embolization techniques should be well trained to get good results and avoid complications. The long term efficacy of Onyx embolization needs to be followed up.  ??Key words: cerebral arteriovenous malformation;endovascular therapy  ??脑动静脉畸形(cerebral arteriovenous malformation，cAVM)是颅内常见的先天性血管疾病，血管内栓塞治疗是主要的治疗方法之一。Onyx胶是一种新型不粘胶，具有不粘管，可以在病灶内长时间缓慢注射等优点。我院从2005年1月起至2008年8月，应用Onyx胶栓塞治疗cAVM 21例，总结报告如下。  ??1 资料和方法  ??1.1 一般资料 本组男12例，女9例。年龄12～48岁。临床首发症状为单纯性头痛6例，头痛伴呕吐4例，癫疒间大发作6例，意识不清2例，肢体无力2例，肢体麻木1例。病程1h～30年，其中急起发病15例。  ??1.2 影像资料 头颅CT显示大脑半球内血肿5例，蛛网膜下腔出血2例，小脑出血2例，脑室出血1例。头颅CT、MRI和DSA检查显示脑动静脉畸形位