脑动静脉畸形栓塞治疗术并发颅内出血的原因及处理  

Intracranial hemorrhage due to embolization therapy for cerebral arteriovenous malformation:its causes and management

作　　者：石潆[1] 赵卫[1] 沈进[1] 姜永能[1] 胡继红[1] 易根发[1] 

机构地区：[1]昆明医学院第一附属医院影像中心,650031

出　　处：《介入放射学杂志》2012年第3期185-189,共5页Journal of Interventional Radiology

摘　　要：目的探讨栓塞治疗脑动静脉畸形(AVM)及并发颅内出血的原因和处理方法。方法2006年至2011年收治45例脑AVM患者,其中35例为首发症状,表现为颅内血肿21例,蛛网膜下腔出血14例。6例患者反复出血2～4次不等。畸形血管团直径3～15 cm,平均(6.84±2.52)cm;体积50～200cm^3,平均(133.83±43.32)cm^3。对所有患者均采用Onyx液体栓塞剂进行栓塞治疗,并进行随访,观察有无并发症发生。结果45例中,37例随防时间3个月～3年,平均15个月;优31例(83.7%),良5例(13.5%),差1例(2.7%),无重残及死亡。栓塞术后出现颅内出血7例,均不同程度存在正常灌注压突破,2例行开颅血肿清除,其余均为小型血肿自行吸收。7例出血者中,2例痊愈,4例神经功能障碍,1例偏瘫。结论脑AVM栓塞治疗术并发颅内出血的机制较为复杂,掌握其发生机制可以更好地控制诱发因素,减少并发症的发生。Objective To investigate the causes of cerebral hemorrhage occurred after interventional embolization treatment of arteriovenous malformation （AVM）, and to discuss its effective management. Methods A total of 45 patients with AVM, encountered during the period from 2006 to 2011, were enrolled in the study. Thirty-five patients showed signs of intracranial hematoma （n -- 21 ） or subarachnoid hemorrhage （n = 14） as initial symptoms. Recurrent cerebral hemorrhage （2 - 4 times） was seen in 6 patients. The diameter of the abnormal vascular ball was 3 - 15 cm with a mean of （6.84 ± 2.52） cm, the lesion＇s volume was 50 - 200 cm3 with a mean of （133.83± 43.32） cm3. Embolization therapy with liquid Onyx was carried out in all patients. Follow-up was conducted and the complication was documented. The clinical results were analyzed. Results Thirty-seven patients were followed up for 3 months to 3 years （mean of 15 months）. Excellent respond was obtained in 31 cases （83.7%）, good result was observed in 5 cases （13.5%） and poor effect was seen in one case （2.7%）. No severe disability or death occurred. Intracranial hemorrhage occurred in 7 patients after embolization therapy. Craniotomy was carried out in two cases to remove the hematoma, and in the remaining 5 cases the small hematomas were absorbed spontaneously. Of the 7 patients with intracranial hemorrhage, complete cure was achieved in 2, dysneuria remained in 4 and hemiparalysis developed in one. Conclusion The mechanism of cerebral hemorrhage occurred after the interventional embolization treatment for cerebral AVM is complex. A comprehensive understanding of its causes can effectively control its inducing factors and reduce its complications.

关 键 词：脑动静脉畸形 颅内出血 血管内栓塞 并发症 

分 类 号：R651.1[医药卫生—外科学]