应用Onyx-18行血管内栓塞脑动静脉畸形的临床分析  

Clinical analysis of endovascular treatment in cerebral arteriovenous malformation with Onyx-18

作　　者：张品元[1] 侯凯[1] 徐丽峰[1] 井山泉[1] 宋剑[1] 

机构地区：[1]河北医科大学第一医院神经外科,河北石家庄050031

出　　处：《临床荟萃》2011年第11期948-950,956,F0002,共5页Clinical Focus

摘　　要：目的探讨应用Onyx-18血管内栓塞脑动静脉畸形的临床治疗经验。方法回顾性分析我科近5年来应用Onyx-18治疗脑动静脉畸形患者16例,就其临床表现、影像学、治疗策略及结果进行临床研究。结果Spetzler分级：Ⅱ级3例,Ⅲ级4例,Ⅳ级7例,Ⅴ级2例。16例患者中共进行20次栓塞,完全栓塞5例（31.2%）,90%栓塞5例（31.2%）差6例。7例患者出现术后头痛,给予甘露醇脱水后症状缓解;3例出现一过性肢体偏瘫、麻木,给予相应处理后其中3例完全恢复;2例出现一过性言语不利,对症处理后症状消失;2例发生微导管拔管失败,滞留体内,术后其中1例患者出现残留右上肢轻瘫。所有患者随访6~36个月,经全脑血管造影证实未发现畸形血管团再通现象。13例格拉斯哥预后评分（GOS）=5;1例GOS=4;2例GOS=3。结论Onyx-18行血管内栓塞脑动静脉畸形安全可行,在临床上能够取得令人满意的脑血管畸形治愈率,可以有效将大的血管畸形减容,为进一步治疗创造条件。熟练掌握栓塞操作技巧及预防措施,可以使脑动静脉畸形获得更高的治愈率。Objective To explore the clinical experience of application of Onyx-18 used in endovascular embolization treatment of cerebral arteriovenous malformation.Methods Retrospective analysis was carried out on the application of Onyx-18 in our department for the treatment of 16 cases of cerebral arteriovenous malformation from 5 years last.The analysis mainly focused on clinical manifestation,imaging,treatment strategy and clinical result.Results According to Spetzler classification,3 cases were ranked as grades Ⅱ,4 as grades Ⅲ,7 as grades Ⅳ and 2 as grades Ⅴ.16 patients were embolized for 20 times.Complete embolization was 5 cases（31.2%） and 90% embolization was 5 cases（31.2%）.Postoperative headache occurred in 7 cases and the symptoms were alleviated after administration of mannitol for system dehydration;transient limb hemiplegia and numbness occurred in 3 cases and all recovered completely after corresponding treatment;transient difficulty in speech occurred in 2 patients and the symptoms disappeared after symptomatic treatment;extubation failure of microcatheter occurred in 2 cases resulting in residue in body,and within whom 1 case experienced right upper limb paresis after surgery.All patients were randomly followed from 6 to 36 months and no recanalization of malformed vein mass was observed by cerebral angiography.13 cases were Glasgow Outcome Scale（GOS）5,1 was GOS 4 and 2 were GOS 3.Conclusion The application of Onyx-18 is safe and feasible in endovascular embolization treatment of cerebral arteriovenous malformation.The recovery rate of treatment of cerebral arteriovenous malformation is satisfactory.The large volume of vascular malformation was reduced effectively for further treatment.The recovery rate of arteriovenous malformation can be increased by masterful embolization skill and careful preventive measures.

关 键 词：颅内动静脉畸形 栓塞 治疗性 诊断显像 治疗结果 

分 类 号：R742[医药卫生—神经病学与精神病学]