栓塞联合伽玛刀治疗后颅窝动静脉畸形的临床疗效分析
发布时间：2018-10-14 08:35
【摘要】：目的:探讨栓塞联合伽玛刀(Gamma Knife Surgery,GKS)治疗后颅窝动静脉畸形(cerebralarteriovenous malformations,AVM)的临床疗效。方法:回顾性分析北京天坛医院神经介入科2011年12月至2015年12月间收治的栓塞联合GKS治疗的32名后颅窝AVM患者的临床及影像学资料。统计患者年龄、性别、临床表现以及AVM体积、是否合并动脉瘤、供血动脉、引流静脉、Spetzler-Martin分级及栓塞治疗过程、GKS治疗的边缘剂量和中心剂量等。随访畸形血管团的闭塞率、是否发生颅内再出血及神经功能障碍,分析联合治疗的影像学结果及临床效果。结果:32例后颅窝AVM患者中男性15例,女性17例,平均年龄29岁(6-66岁),12例(37.5%)患者合并动脉瘤。临床表现为突发颅内出血23例,局灶性神经功能缺失4例,头晕3例,头痛2例。根据Spetzler-Martin分级:II级8例,III级17例,IV级7例。32例患者共进行了42次血管内栓塞治疗,每例患者栓塞1-4次,平均1.41次,栓塞术后6例(18.8%)患者出现了与血管内栓塞治疗相关的并发症,其中1例(3.1%)出现蛛网膜下腔出血(SAH),随访时仅2例患者存在永久性的神经功能障碍。所有入组病例均为行部分栓塞的患者,并于栓塞一周之后行GKS治疗。术后1例出现脑出血,2例出现放射性脑水肿,保守治疗后均好转。32名患者均接受了临床或电话随访,随访12-60个月,其中较入院时症状改善21例,症状稳定9例,2例(6.3%)患者遗留永久神经功能障碍。32例患者均接受了影像随访,造影显示完全闭塞15例,畸形团缩小17例,闭塞率为46.9%。统计结果显示栓塞术后AVM形状集中,GKS治疗前最大直径≤3cm、GKS治疗前体积≤6cm~3、GKS术后≥2年,联合治疗治愈率越高(P0.05)。结论:栓塞联合GKS治疗后颅窝AVM是一种有效的治疗方法。针对性栓塞可以消除畸形团中的薄弱环节,能降低出血风险;通过栓塞畸形供血动脉可以减小畸形团的体积,提高GKS治疗后畸形团的闭塞率。
[Abstract]:Objective: to investigate the clinical effect of embolization combined with gamma knife (Gamma Knife Surgery,GKS) in the treatment of arteriovenous malformation (cerebralarteriovenous malformations,AVM) in posterior cranial fossa. Methods: the clinical and imaging data of 32 patients with posterior cranial fossa AVM treated by embolization combined with GKS from December 2011 to December 2015 were retrospectively analyzed. Age, sex, clinical manifestation and volume of AVM were counted. The patients were complicated with aneurysm, blood supply artery, drainage vein, Spetzler-Martin grade and embolization process, marginal dose and central dose of GKS treatment, etc. The rate of occlusion, intracranial rebleeding and neurological dysfunction were followed up. The imaging results and clinical results of combined treatment were analyzed. Results: in 32 patients with posterior cranial fossa AVM, there were 15 males and 17 females with an average age of 29 years (6-66 years) and 12 cases (37.5%) with aneurysms. The clinical manifestations were sudden intracranial hemorrhage in 23 cases, focal nerve loss in 4 cases, dizziness in 3 cases and headache in 2 cases. According to the Spetzler-Martin classification, there were 8 cases of II grade, 17 cases of III grade and 7 cases of IV grade. A total of 42 times of endovascular embolization was performed in 32 cases. Each patient underwent embolization for 1-4 times (average 1.41 times). Six patients (18.8%) had complications related to endovascular embolization. One case (3.1%) had subarachnoid hemorrhage (SAH),) and only 2 cases had permanent neurological dysfunction. All patients were treated with partial embolization and treated with GKS one week after embolization. Postoperative cerebral hemorrhage occurred in 1 case and radiation brain edema in 2 cases. All 32 patients were followed up by clinical or telephone for 12 to 60 months. The symptoms were stable in 9 cases, 2 cases (6.3%) were left with permanent neurological dysfunction. All 32 cases were followed up by imaging. 15 cases were completely occluded, 17 cases were constricted, and the obliteration rate was 46.9%. The statistical results showed that after embolization, the shape of AVM was concentrated, the maximum diameter of GKS before treatment was 鈮，
本文编号：2269930
[Abstract]:Objective: to investigate the clinical effect of embolization combined with gamma knife (Gamma Knife Surgery,GKS) in the treatment of arteriovenous malformation (cerebralarteriovenous malformations,AVM) in posterior cranial fossa. Methods: the clinical and imaging data of 32 patients with posterior cranial fossa AVM treated by embolization combined with GKS from December 2011 to December 2015 were retrospectively analyzed. Age, sex, clinical manifestation and volume of AVM were counted. The patients were complicated with aneurysm, blood supply artery, drainage vein, Spetzler-Martin grade and embolization process, marginal dose and central dose of GKS treatment, etc. The rate of occlusion, intracranial rebleeding and neurological dysfunction were followed up. The imaging results and clinical results of combined treatment were analyzed. Results: in 32 patients with posterior cranial fossa AVM, there were 15 males and 17 females with an average age of 29 years (6-66 years) and 12 cases (37.5%) with aneurysms. The clinical manifestations were sudden intracranial hemorrhage in 23 cases, focal nerve loss in 4 cases, dizziness in 3 cases and headache in 2 cases. According to the Spetzler-Martin classification, there were 8 cases of II grade, 17 cases of III grade and 7 cases of IV grade. A total of 42 times of endovascular embolization was performed in 32 cases. Each patient underwent embolization for 1-4 times (average 1.41 times). Six patients (18.8%) had complications related to endovascular embolization. One case (3.1%) had subarachnoid hemorrhage (SAH),) and only 2 cases had permanent neurological dysfunction. All patients were treated with partial embolization and treated with GKS one week after embolization. Postoperative cerebral hemorrhage occurred in 1 case and radiation brain edema in 2 cases. All 32 patients were followed up by clinical or telephone for 12 to 60 months. The symptoms were stable in 9 cases, 2 cases (6.3%) were left with permanent neurological dysfunction. All 32 cases were followed up by imaging. 15 cases were completely occluded, 17 cases were constricted, and the obliteration rate was 46.9%. The statistical results showed that after embolization, the shape of AVM was concentrated, the maximum diameter of GKS before treatment was 鈮，
本文编号：2269930
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