CAJ | 학술논문

目的：分析大型脑动静脉畸形（AVM）的分次栓塞治疗方法和策略。方法2005年5月-2013年5月对35例大型脑 AVM 患者行血管内分次栓塞治疗。大型脑 AVM 主要位于额叶11例，顶叶8例，颞叶6例，枕叶4例，侧颞区2例，脑白质深部及基底节区4例。畸形血管团最长径为6～12 cm，平均7．23 cm，均为多支供血，（2～5支）。浅静脉引流13例，深静脉引流9例，深浅静脉均引流17例；静脉出口狭窄3例，扩张6例。造影见右侧16例，左侧19例。结果35例患者共分行91次手术、297次栓塞治疗，其中栓塞使用 NBCA 107次，ONYX 胶153次，福爱乐医用胶15次，联合治疗使用 NBCA 和 ONYX胶9例，ONYX 和联合福爱乐医用胶13例，治疗后无死亡病例，大型 AVM 患者第1次栓塞后，剩余畸形团体积大多<50%，平均1～3个月后予以2次或多次栓塞治疗，最后完全栓塞者26例，大部栓塞（>80%）者9例，术后恢复情况良好。经分次栓塞后，畸形血管团体积逐渐减少，最终达到临床治愈，或为显微神经外科手术切除或放射治疗奠定基础。结论对于大型 AVM 进行血管内分次栓塞治疗效果肯定，值得临床推广应用。
목적：분석대형뇌동정맥기형（AVM）적분차전새치료방법화책략。방법2005년5월-2013년5월대35례대형뇌 AVM 환자행혈관내분차전새치료。대형뇌 AVM 주요위우액협11례，정협8례，섭협6례，침협4례，측섭구2례，뇌백질심부급기저절구4례。기형혈관단최장경위6～12 cm，평균7．23 cm，균위다지공혈，（2～5지）。천정맥인류13례，심정맥인류9례，심천정맥균인류17례；정맥출구협착3례，확장6례。조영견우측16례，좌측19례。결과35례환자공분행91차수술、297차전새치료，기중전새사용 NBCA 107차，ONYX 효153차，복애악의용효15차，연합치료사용 NBCA 화 ONYX효9례，ONYX 화연합복애악의용효13례，치료후무사망병례，대형 AVM 환자제1차전새후，잉여기형단체적대다<50%，평균1～3개월후여이2차혹다차전새치료，최후완전전새자26례，대부전새（>80%）자9례，술후회복정황량호。경분차전새후，기형혈관단체적축점감소，최종체도림상치유，혹위현미신경외과수술절제혹방사치료전정기출。결론대우대형 AVM 진행혈관내분차전새치료효과긍정，치득림상추엄응용。
Objective To discuss the therapeutic methods and strategies of fractionated embolization in treating large cerebral arteriovenous malformation (cAVM). Methods During the period from May 2005 to May 2013 at authors’ hospital, endovascular fractionated embolization was performed in 35 cases with large cAVM. The lesions were located in the frontal lobe (n = 11), the parietal lobe(n = 8), the temporal lobe (n = 6), the occipital lobe (n = 4), the lateral temporal area (n = 2) and the deep white matter and basal ganglia (n = 4). The longest diameter of the lesions was 6 - 12 cm, with a mean of 7.23 cm. The number of supply vessels was 2 - 5. The lesions were drained by superficial veins in 13 cases, by deep veins in 9 cases and by both superficial and deep veins in 17 cases. The exit stenosis of the draining vein was seen in 3 cases, while the dilatation of the draining vein was found in 6 cases. Angiography showed that the lesions were situated at the right side in 16 cases and at the left side in 19 cases. Results A total of 297 times of embolization operating-process were carried out in the 35 patients, of which NBCA was used in 107, ONYX in 153 with, FuAiLe medical adhesive in 15, combination use of NBCA and ONYX in 9 and combination use of ONYX and FuAiLe medical adhesive in 13. No death occurred after treatment. After the first embolization, the residual malformation volume usually decreased to < 50%. The interval between the first and the second embolization was 1 - 3 months. Generally, two to four times of embolization were performed in each patient. Complete occlusion of the lesion was obtained in 26 cases, and sub - complete occlusion of the lesion (> 80%embolization) in 9 patients. Good recovery was achieved in all patients. After fractionated embolization, the volume of the cAVMs was decreased gradually and ultimate clinical cure was achieved, which laid the foundation for conducting further micro - neruosurgery or radiation therapy. Conclusion For the treatment of large cerebral arteriovenous malformation, fractionated embolization has reliable therapeutic effect. Therefore, this technique should be recommended in clinical practice.