Embolization of ruptured arteriovenous malformations in the cerebellopontine angle cistern.
Embolization of ruptured arteriovenous malformations in the cerebellopontine angle cistern.
复制标题
桥小脑角池破裂动静脉畸形的栓塞治疗。
DOI：
10.1007/s10143-017-0832-1
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Tominaga T.
中科院分区：
文献类型：
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作者：
Endo H;Osawa SI;Matsumoto Y;Endo T;Sato K;Niizuma K;Fujimura M;Tominaga T.
在脑干动静脉畸形（AVM）中，存在主要位于桥小脑角池（CPAC）的小AVM，其延伸至脑干软脑膜表面的程度最小。然而，之前的CPAC AVM研究并未特别讨论栓塞在这些病变治疗中的作用。本研究旨在阐明栓塞治疗CPAC AVM的有效性和有效性。我们回顾性分析了5例接受血管内治疗的CPAC AVM患者。这些患者接受了栓塞治疗，然后进行开放手术或伽玛刀（GK）放射外科治疗。然后对这些患者的影像学检查结果和临床病程进行评估。所有5名患者均出现出血。血管造影显示，所有病例的主要供血动脉均包含扩张的桥脑穿通动脉。通过扩张的脑桥穿通动脉栓塞有效地减少了病灶内的分流或闭塞了相关的动脉瘤。磁共振成像显示四名患者的外侧脑桥脑梗死，其中一名患者出现短暂的轻度头晕和右侧轻度共济失调。3例患者随后进行了开放手术，2例患者进行了GK放射外科手术，无并发症。在随访期结束时，所有患者均表现出良好的结局。所有患者均未发生术后再出血。除1例接受GK治疗的患者外，4例患者确认AVM消失。尽管应注意缺血性并发症，但栓塞CPAC AVM可能是降低后续手术或放射外科手术风险的适当治疗选择。
Among brainstem arteriovenous malformations (AVMs), there exist small AVMs predominantly located in the cerebellopontine angle cistern (CPAC) with minimal extension into the pial surface of the brainstem. However, previous studies of CPAC AVMs did not particularly discuss the role of embolization in the treatment of these lesions. This study was conducted to clarify the effectiveness and validity of embolization in the treatment of CPAC AVMs. We retrospectively reviewed five patients with CPAC AVMs who underwent endovascular treatment. These patients were treated with embolization followed by open surgery or gamma knife (GK) radiosurgery. Radiological findings and clinical course for these patients were then assessed. All five patients presented with a hemorrhage. Angiography revealed that the main feeder contained a dilated pontine perforating artery in all cases. Embolization through the dilated pontine perforating artery effectively reduced shunt flow within the nidus or obliterated associated aneurysms. Magnetic resonance imaging showed infarction on the lateral pons in four patients, one of which developed transient mild dizziness and mild ataxia of the right side. Subsequent open surgery was performed in three patients, and GK radiosurgery was performed in two patients without complications. At the end of the follow-up period, all patients demonstrated favorable outcomes. Postoperative rebleeding did not occur in any of the patients. Disappearance of the AVM was confirmed in four patients, except in the one patient treated with GK. Although ischemic complications should be noted, embolization of CPAC AVMs may be an appropriate treatment option to reduce the risk of subsequent surgery or radiosurgery.