THE EFFECT OF EMBOLIZATION WITH N-BUTYL CYANOACRYLATE PRIOR TO SURGICAL RESECTION OF CEREBRAL ARTERIOVENOUS-MALFORMATIONS
THE EFFECT OF EMBOLIZATION WITH N-BUTYL CYANOACRYLATE PRIOR TO SURGICAL RESECTION OF CEREBRAL ARTERIOVENOUS-MALFORMATIONS
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DOI：
10.3171/jns.1993.78.1.0060
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发表时间：
1993-01-01
影响因子：
4.1
通讯作者：
KUPERSMITH, MJ
中科院分区：
文献类型：
--
作者：
JAFAR, JJ;DAVIS, AJ;KUPERSMITH, MJ
脑动静脉畸形（AVM）的血管内治疗是一种公认的外科治疗辅助方法。然而，文献没有描述术前栓塞的受益或责任。该系列比较了接受脑AVM手术切除术的两组患者;一组（20例患者）接受了术前经股动脉选择性氰基丙烯酸正丁酯（NBCA）栓塞，另一组（13例患者）未接受。与未栓塞组相比，术前栓塞组的AVM更大（3.9与2.3 cm），Spetzler-Martin分级更高（3.2与2.5）。NBCA栓塞有助于手术切除。血管畸形的供血动脉与正常脑实质的供血动脉很容易区分。栓塞的血管可压缩，易于用显微剪刀切割。横切血管未发生出血。两组的手术时间和术中失血量无统计学差异，尽管病变大小和分级存在显著差异。血管内并发症包括即刻和迟发性出血（15%）和短暂性缺血（5%）;无栓塞相关死亡。两组的术后并发症包括出血（15%）、残余AVM（6%）和脑脊液漏（3%）;死亡率为3%。栓塞组和非栓塞组之间的手术并发症没有统计学显著差异。两组中大多数患者（91%）的晚期神经功能结局均为优或良，两组之间无显著差异。本研究得出结论，AVM的术前NBCA栓塞通过减少手术时间和术中失血量，使较大尺寸和较高级别的病变成为较小尺寸和较低级别病变的手术等效物，在手术并发症或长期神经结局方面无统计学显著差异。
Endovascular therapy of cerebral arteriovenous malformations (AVM's) is an accepted adjunct to surgical therapy. However, the literature has not characterized the benefits or the liabilities of preoperative embolization. This series compares two groups of patients who underwent surgical resection of a cerebral AVM; one group (20 patients) received preoperative transfemoral selective embolization with N-butyl cyanoacrylate (NBCA) and the other group (13 patients) did not. In the group with preoperative embolization, the AVM's were larger (3.9 vs. 2.3 cm) and of a higher Spetzler-Martin grade (3.2 vs. 2.5) as compared to the nonembolized group. The NBCA embolization facilitated surgical resection. Arteries supplying the vascular malformation were readily distinguished from those supplying the normal brain parenchyma. Embolized vessels were compressible and easily cut with microscissors. No bleeding occurred from transected vessels. Operative time and intraoperative blood loss for the two groups were not statistically different, despite the significant differences in lesion size and grade. Endovascular complications included immediate and delayed hemorrhage (15 %) and transient ischemia (5 %); there were no embolization-related deaths. Postoperative complications for both groups included hemorrhage (15 %), residual AVM (6 %), and cerebrospinal fluid leak (3 %); the mortality rate was 3 %. There was no statistically significant difference in surgical complications between the embolized and nonembolized groups. Most patients (91 %) in both groups had an excellent or good late neurological outcome, with no significant difference between the groups. This study concludes that preoperative NBCA embolization of AVM's makes lesions of larger size and higher grade the surgical equivalent of lesions of smaller size and lower grade by reducing operative time and intraoperative blood loss, with no statistically significant difference in surgical complications or long-term neurological outcome.