Onyx胶栓塞脑动静脉畸形31例

背景：在脑动静脉畸形的血管内栓塞治疗中,栓塞材料的选用在很大程度上决定血管内栓塞治疗的效果。Onyx胶是近年研制的一种新型液体栓塞剂,具有不粘管、弥散均匀及可控性好等优点。 目的：总结新型液态栓塞剂Onyx胶栓塞脑动静脉畸形31例的技术要点和临床疗效。 方法：应用Onyx胶栓塞脑动静脉畸形31例,均采用Seldinger技术在股动脉内置入6F动脉鞘,6F导引导管插入颈内动脉或椎动脉,Marathon微导管超选择进入畸形血管团内,采用“注胶-返流-停止-再注胶”技术长时间缓慢注射Onyx胶栓塞脑动静脉畸形。 结果与结论：栓塞后脑动静脉畸形闭塞40%~60% 8例,60%~90% 7例,90%以上(完全栓塞)16例。未能完全栓塞的15例中,4例接受手术治疗,其中3例痊愈,1例单侧肢体乏力,肌力Ⅳ级;6例患者术后辅以伽玛刀治疗,其中2例1年以后复查DSA显示脑动静脉畸形完全闭塞。提示Onyx可提高脑动静脉畸形的栓塞效果,但应正确采用栓塞技术和注意预防并发症。

Embolization of cerebral arteriovenous malformation with Onyx in 31 cases

BACKGROUND:As for the endovascular embolization treatment of cerebral arteriovenous malformations, the embolic materials play a greatly decisive role on the therapeutic effect. Onyx is a new liquid embolic agent developed in recent years, with non-stick tube, dispersion uniformity and good controllability. OBJECTIVE:To summarize the embolization techniques and clinical efficacy of cerebral arteriovenous malformation by using a new liquid embolic agent (Onyx). METHODS:Thirty-one patients with cerebral arteriovenous malformation were treated with Onyx, 6F sheath inserted into femoral artery using Seldinger technique followed by 6F guiding catheter introduced into the internal carotid artery or vertebral artery, Marathon micro-catheter could be navigated into the nidus of arteriovenous malformation, then the Onyx was injected slowly into the cerebral arteriovenous malformation with “inject-back flow-stop-reinject” technique. RESULTS AND CONCLUSION:40%-60% embolizations were achieved in 8 cases, 60%-90% in 7 cases, more than 90% (complete embolization) in 16 cases. Among 15 cases of incomplete embolization, 4 underwent surgical removal including 3 cases with good outcome and 1 case of hemiplegia with muscular strength of degree Ⅳ; 6 cases were treated by γ-knife after embolization, 2 cases of them showed complete occlusion after radiosurgery. Onyx has unique and distinctive superiority in treating cerebral arteriovenous malformations. However, the embolization techniques should be well trained to get good results and avoid complications.