脑动静脉畸形血管内栓塞治疗的疗效和安全性

A. El-rahamany, Y. Barakat, Ahmed M. Elsherif
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摘要

背景:脑动静脉畸形(AVMs)的血管内栓塞有几个好处,包括AVM闭塞和血流减少,为其他治疗技术做准备。目的:评价不同技术和材料在脑动静脉畸形血管内栓塞治疗中的疗效和安全性。患者和方法:在一项前瞻性和回顾性研究中,22例诊断为AVM或动静脉瘘的患者在神经外科介入单元等行血管内栓塞术。侯赛因大学医院于2020年1月初至2022年5月底期间招募。作者纳入年龄在1个月以上,诊断为脑动静脉畸形或动静脉瘘的患者。近期脑出血患者至少延迟2周。作者排除了Galen静脉畸形患者、新生儿AVM患者、手术切除患者、有放射或染料注射禁忌的患者,以及血管严重扭曲等无法进入血管内技术的患者。结果:本组患者平均年龄为24.5±14.7岁。男性居多(68.2%)。绝大多数病例(86.4%)表现为头痛,40.9%出现出血,31.8%出现侧无力,27.3%出现痉挛。栓塞后脑动静脉畸形的Spetzler和Martin评分较初始评分明显改善(P < 0.002)。根据Spetzler和Martin分级,病灶完全闭塞8例,部分闭塞14例。随访3个月后,莫氏Rankin评分、癫痫、头痛均有改善。没有患者出现手术相关并发症。结论:血管内栓塞治疗脑动静脉畸形安全有效
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Efficacy and safety of endovascular embolization of cerebral AVM
Background : Endovascular embolization of cerebral arteriovenous malformations (AVMs) has several bene fi ts including AVM occlusion and fl ow reduction in preparation for other treatment techniques. Aim and objectives : The aim was to assess the ef fi cacy and safety of endovascular embolization of cerebral AVM with different techniques and materials. Patients and methods : In a prospective and retrospective study, 22 patients diagnosed as having AVM or arteriovenous fi stula who underwent endovascular embolization at Neurosurgical Intervention Unit et al. Hussein University Hospital were recruited in the period from the beginning of January 2020 to the end of May 2022. The authors included patients aged above 1 month, diagnosed to have cerebral AVM or arteriovenous fi stula. Patients with recent cerebral hemorrhage were delayed for at least 2 weeks. The authors excluded patients with vein of Galen malformation, neonatal AVM, patients who underwent surgical excision, patients with contraindication to radiation or dye injection, and inaccessible endovascular techniques such as severely tortuous vessels. Results : In the current study, the mean age was 24.5 ± 14.7 years. Most cases were male (68.2%). Most cases (86.4%) manifested headache, 40.9% had hemorrhage, 31.8% had side weakness, and 27.3% had fi ts. Spetzler and Martin grade of the cerebral AVMs was signi fi cantly improved after embolization compared with the initial grading score ( P ¼ 0.002). Eight patients showed complete occlusion of nidus and 14 had partial occlusion according to Spetzler and Martin grade. After 3 months of follow-up, modi fi ed Rankin scale, epilepsy, and headache were improved. No patient had procedure-related complications. Conclusion : Endovascular embolization is safe and effective in patients with cerebral AVM
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