远距离注射Onyx胶介入栓塞联合伽玛刀治疗脑动静脉畸形  

Onyx embolization by distant injection combined with gamma-knife surgery in treatment of brain arteriovenous malformations

作　　者：张龙[1] 刘保国[1] 李伟光[2] 冯文峰[2] 李平安[1] 冯金福[1] 肖罡[1] 何黎明[1] 

机构地区：[1]汕头大学医学院附属粤北人民医院神经外科,韶关512026 [2]南方医科大学南方医院,广州510515

出　　处：《新医学》2015年第11期748-752,共5页Journal of New Medicine

基　　金：韶关市科技计划(医学类)项目(2014CX/K266);韶关市医学科研基金(Y14048)

摘　　要：目的探讨采用远距离注射Onyx胶介入栓塞联合伽玛刀治疗脑动静脉畸形（AVM）的临床应用价值。方法采用远距离注射Onyx胶介入栓塞13例脑AVM,残留畸形血管团行伽玛刀治疗。采用格拉斯哥预后量表（GOS）评估出院情况,使用改良Rankin量表（mRS）评价预后。结果13例脑AVM患者共计实施16次栓塞手术,栓塞结束后即刻复查脑血管造影,畸形血管团体积缩小25%~85%,平均缩小（50.3±17.9）%。均未出现与栓塞相关的并发症,1例伽玛刀治疗后出现放射性脑水肿。出院时,GOS达5分11例（85%）。随访6~18个月,其中11例脑AVM完全不显影,2例脑AVM较出院时明显缩小,mRS小于3分12例。结论采用远距离注射Onyx胶介入栓塞治疗脑AVM安全可行,可减少术者射线暴露风险,联合伽玛刀治疗可获得理想的临床疗效。Objective To evaluate the clinical value of Onyx embolization by distant injection in combination with gamma-knife surgery in treating brain arteriovenous malformation （AVM）.Methods Thir-teen patients with brain AVMwere treated with distant injection of Onyx and the residual brain AVMwas sub-ject to gamma-knife surgery.Clinical status at discharge was evaluated using Glasgow Outcome Scale （GOS）. Clinical prognosis was assessed by modified Rankin Scale （mRS）.Results All 13 AVM patients underwent embolization surgery for 16 times.Cerebral angiography was performed immediately after surgery and revealed that the volume of the AVMwas reduced by 25%-85%,（50.3 ±17.9）on average.No embolization-related complications were noted.Brain edema was found in one patient after undergoing gamma-knife surgery.Upon discharge,11 patients （85%）had GOS score 〉5.Postoperative follow-up endured from 6 to 18 months. During follow-up,AVMof 11 cases were completely occluded,the volume of AVMnidus was obviously shrank in 2 cases,and 12 patients had mRS score 〈3.Conclusions Distant injection of Onyx is a feasible and safe treatment of brain AVM and minimizes radiation exposure to the surgeons.High clinical efficacy can be a-chieved when it is combined with gamma-knife surgery.

关 键 词：远距离注射 ONYX胶 伽玛刀 脑动静脉畸形 

分 类 号：R743.4[医药卫生—神经病学与精神病学]