摘要
目的探讨Onyx胶栓塞颅内动静脉畸形（AVM）联合伽玛刀治疗的有效性和安全性。方法回顾性分析2004年4月至2011年9月首都医科大学北京市神经外科研究所神经介入中心收治的86例经Onyx胶栓塞后联合伽玛刀治疗的颅内AVM患者，统计分析栓塞的相关并发症及临床预后。栓塞AVM时，对合并的高危出血风险（巢内动脉瘤、血流动力性动脉瘤和AVM相关性动静脉瘘）进行评估并栓塞，将合并高危因素的颅内AVM根据危险因素栓塞与否，分为靶向栓塞组和未靶向栓塞组，评估靶向栓塞对出血风险的作用。结果总体颅内AVM患者的年出血率为1．66％，其中破裂AVM为2．26％，未破裂AVM为1．08％，年病死率为0．74％。16例栓塞相关并发症中1例出现永久性神经功能障碍。29个合并巢内动脉瘤中24个靶向栓塞；5个血流动力性动脉瘤中4个靶向栓塞；9个动静脉瘘中8个靶向栓塞。χ^2检验显示靶向栓塞组的出血并发症显著低于未靶向栓塞组（P〈0．01）。结论靶向栓塞联合伽玛刀治疗能降低颅内AVM出血的风险，改善临床预后，降低永久性并发症的发生。此方法适用于治疗体积较大、单一方案无法治愈的颅内AVM。
Objective To investigate the effectiveness and safety of Onyx enbolization in combination with gamma knife surgery for the treatment of intraeranial arteriovenous malformations （AVMs）. Methods A total of 86 patients with AVM admhted to the Neurological intervention Center, Beijing Neurosurgery Institute, Capital Medical University and treated with Onyx embolization in combination with gamma knife surgery from April 2004 to September 2011 were analyzed retrospectively. The related complications and clinical prognosis of embolization were counted and analyzed. During the emboiization of AVMs, the combined high risk of bleeding （intraeranial aneurysms, hemodynamie aneurysms, and AVM-related arteriovenons fistula） were assessed and embolized. According to the risk factors and embolization or not, the intracranial AVMs with high risk factors were divided into either a targeted embolization group or a non-targeted em^lization group. The effect of targeted embolization on hemorrhage risk was assessed. Results The overall annual hemorrhage rate in patients with AVM was 1.66%, and the ruptured AVM was 2. 26%, the unruptured AVM was 1.08%, and the annual mortality rate was 0. 74%. One of 16 patients with embolization related complications had permanent neurological dysfunction. Twenty-four of 29 patients complicated with intranidal aneurysm underwent targeted embolization; 4 of 5 patients with hemodynamic aneurysm underwent targeted embolization; and 8 of 9 patients with arteriovenous fistula underwent targeted embolization. Chi square test showed that the hemorrhage complications of the targeted embolization group was significantly lower than that of the non-targeted embolization group （P 〈0. 01）. Condusion The targeted embolization in combination with gamma knife surgery may decrease the risk of intracranial AVM hemorrhage, improve clinical prognosis and occur less permanent complications. This method is suitable for the treatment of intracranial AVMs of larger volume and those can not be cured with a single program.
出处
《中华神经外科杂志》
CSCD
北大核心
2015年第11期1126-1130,共5页
Chinese Journal of Neurosurgery
基金
首都医学发展科研基金（2009-2067）
关键词
颅内动静脉畸形
脑血管造影术
放射疗法
出血
手术后并发症
Intracranial arteriovenous malformations
Cerebral angiography
Radiotherapy
Hemorrhage
Postoperative complication
作者简介
通信作者：李佑祥，Email：liyouxiang@263．net
