中国脑血管病杂志2016，Vol.13Issue(3)：123-127,5.DOI:10.3969/j.issn.1672-5921.2016.03.003
血管内栓塞结合二期立体定向放射外科治疗颅内动静脉畸形的效果
Effect of endovascular embolization combined with two-stage stereotacticradiosurgery for the treatment of intracranial arteriovenous malformation
诸德源 1赵文元 1刘建民 1方亦斌 1黄清海 1刘炜 2李仁利 2祝国荣 2李强 1许奕 1洪波1
作者信息
- 1. 200433 上海，第二军医大学附属长海医院神经外科
- 2. 解放军第四一一医院伽玛刀科
- 折叠
摘要
Abstract
Objective To investigate the safety and effectiveness of endovascular embolization combined with two-stage stereotacticradiosurgery (SRS)for the treatment of intracranial arteriovenous malformation (AVM). Methods From January 2010 to December 2012,the clinical data of 66 patients treated with endovascular embolization combined with two-stage SRS AVM comprehensive therapy at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were analyzed retro-spectively. They were followed up by imaging. The followed-up time was 7 to 96 months. DSA revealed that the complete disappearance of vascular flow void shadow was regarded as a cure. The patients were divided into either a cured group (n = 29)or a not cured group (n = 37)according whether they were cured or not. The effects of different factors,such as AVM rupture or not,the volume size before embolization,and the degree of embolization on the cure rate of AVM with the comprehensive therapy were observed in both groups,and logistic regression was used to analyze the factors affecting the cure rate of comprehensive therapy. Results (1)There were 22 patients (75. 9%)had ruptured AVMs and 7 (24. 1%)had unruptured AVMs in the cured group. The diameters of the aneurysms < 3 cm and ≥3 cm were in 26 (89. 7%)and 3 (10. 3%)cases respectively. Spetzler-Martin (SM)grades of patients were Ⅰ to Ⅲ. In the not cured group,20 patients (54. 1%)had ruptured AVMs and 17 (45. 9%)had unruptured AVMs. The diameters< 3 cm and ≥3 cm were 18 (48. 6%)and 19 patients (51. 4%)respectively. The SM grade in 34 cases were Ⅰ to Ⅲ. (2)During the follow-up period,29 patients (43. 9%)achieved cure on imaging. The modified Rankin scale (mRS)scores in 64 cases (97%)were 0 to 1. Six patients had complications. (3)Multivariate logistic regression analysis showed that the size of AVM (OR,0. 141,95% CI 0. 035 -0. 570,P < 0. 01)and the degree of interventional embolization (OR,2. 414,95% CI 1. 038 -5. 613,P <0. 05)were the influencing factor of the cure rate. Conclusions Vascular interventional embolization in combination with SRS for the treatment of intracranial AVMs was both effective and safe. The diameter of AVM < 3 cm was the beneficial factor of cure rate of comprehensive therapy. The degree of interventional embolization not reaching cure on imaging was a risk factor for the cure rate of comprehensive therapy.关键词
颅内动静脉畸形/立体定向放射治疗/伽玛刀/介入栓塞/多因素分析Key words
Arteriovenous malformation,intracranial/Stereotacticradiosurgery/Gamma knife/Embolization,interventional/Multivariate analysis引用本文复制引用
诸德源,赵文元,刘建民,方亦斌,黄清海,刘炜,李仁利,祝国荣,李强,许奕,洪波..血管内栓塞结合二期立体定向放射外科治疗颅内动静脉畸形的效果[J].中国脑血管病杂志,2016,13(3):123-127,5.
