Embolization of cerebral arteriovenous malformations with bucrylate.
Embolization of cerebral arteriovenous malformations with bucrylate.
复制标题
丁酸栓塞脑动静脉畸形。
作者：
G. Debrun;F. Viñuela;A. Fox;C. Drake
选择46例脑动静脉畸形（AVM）患者进行丁酸盐栓塞治疗。这些患者被分为三个不同的组。第一组由22例不可切除的AVM患者组成，他们被选择用橡胶校准泄漏球囊栓塞。在这些患者中，有16例实现了栓塞，其中14例部分闭塞了AVM， 2例完全闭塞了。5例患者发生蛛网膜下腔出血，原因是球囊破裂并伴有供血血管剥离。其中4人完全康复，1人死于脑干出血。5例出现永久性脑野缺损，2例出现暂时性轻度神经功能缺损。II组13例患者行术中栓塞治疗。栓塞完全闭塞4例，栓塞后手术完全切除5例。5例患者行部分栓塞术，未行手术切除。其中3名患者有永久性轻度神经功能缺损，2名患者有短暂性神经功能缺损。这一组没有死亡率。第三组11例患者采用新型乳胶校准漏球囊用丁酸盐栓塞治疗。这种气球具有较高的延展性，并采用了精确的馈线配置，没有剥离的风险。这个球囊也允许更快更大的丁酸盐注射到AVM的动脉喂食器。两例AVM完全消失，其他病例的栓塞仅部分成功。神经系统并发症包括2例不完全性视野缺损，1例轻度记忆丧失，1例手臂和面部短暂性笨拙。两名患者将导管永久粘在畸形处，没有神经系统并发症。这一组没有死亡率。
Forty-six patients with cerebral arteriovenous malformations (AVM's) were selected for embolization with bucrylate. These patients were assigned to three different groups. Group I consisted of 22 patients with nonresectable AVM's who were selected for embolization with a Silastic calibrated-leak ballon. In 16 or these patients, embolization was achieved, with partial obliteration of the AVM in 14 and complete obliteration in two. Five patients had subarachnoid hemorrhage caused by the balloon bursting and concomitant dissection of the feeding vessel. Four of these patients recovered completely and one died of a brain-stem hemorrhage. A permanent field defect was noted in five cases, and two patients had a transient mild neurological deficit. Group II consisted of 13 patients treated by intraoperative embolization. Complete obliteration by embolization was obtained in four cases, and complete surgical resection after embolization in five. Partial embolization with no surgical resection was achieved in five cases. Three of these patients had a permanent mild neurological deficit and two had transient deficits. There was no mortality in this group. Group III consisted of 11 patients treated by embolization with bucrylate using a new latex calibrated-leak balloon. This balloon has a higher malleability, and takes on the exact configuration of the feeder, with no risk of dissection. This balloon also permits delivery of the faster and larger injection of bucrylate to the arterial feeders of the AVM. Two AVM's were completely obliterated, and embolization was only partially successful in the other cases. Neurological complications consisted of incomplete field defects in two cases, slight memory loss in one case, and transient clumsiness of the arm and face in one case. Two patients have a catheter permanently glued in the malformation, with no neurological complication. There was no mortality in this group.