【摘要】：目的:探討栓塞聯(lián)合伽瑪?shù)?Gamma Knife Surgery,GKS)治療后顱窩動(dòng)靜脈畸形(cerebralarteriovenous malformations,AVM)的臨床療效。方法:回顧性分析北京天壇醫(yī)院神經(jīng)介入科2011年12月至2015年12月間收治的栓塞聯(lián)合GKS治療的32名后顱窩AVM患者的臨床及影像學(xué)資料。統(tǒng)計(jì)患者年齡、性別、臨床表現(xiàn)以及AVM體積、是否合并動(dòng)脈瘤、供血?jiǎng)用}、引流靜脈、Spetzler-Martin分級(jí)及栓塞治療過程、GKS治療的邊緣劑量和中心劑量等。隨訪畸形血管團(tuán)的閉塞率、是否發(fā)生顱內(nèi)再出血及神經(jīng)功能障礙,分析聯(lián)合治療的影像學(xué)結(jié)果及臨床效果。結(jié)果:32例后顱窩AVM患者中男性15例,女性17例,平均年齡29歲(6-66歲),12例(37.5%)患者合并動(dòng)脈瘤。臨床表現(xiàn)為突發(fā)顱內(nèi)出血23例,局灶性神經(jīng)功能缺失4例,頭暈3例,頭痛2例。根據(jù)Spetzler-Martin分級(jí):II級(jí)8例,III級(jí)17例,IV級(jí)7例。32例患者共進(jìn)行了42次血管內(nèi)栓塞治療,每例患者栓塞1-4次,平均1.41次,栓塞術(shù)后6例(18.8%)患者出現(xiàn)了與血管內(nèi)栓塞治療相關(guān)的并發(fā)癥,其中1例(3.1%)出現(xiàn)蛛網(wǎng)膜下腔出血(SAH),隨訪時(shí)僅2例患者存在永久性的神經(jīng)功能障礙。所有入組病例均為行部分栓塞的患者,并于栓塞一周之后行GKS治療。術(shù)后1例出現(xiàn)腦出血,2例出現(xiàn)放射性腦水腫,保守治療后均好轉(zhuǎn)。32名患者均接受了臨床或電話隨訪,隨訪12-60個(gè)月,其中較入院時(shí)癥狀改善21例,癥狀穩(wěn)定9例,2例(6.3%)患者遺留永久神經(jīng)功能障礙。32例患者均接受了影像隨訪,造影顯示完全閉塞15例,畸形團(tuán)縮小17例,閉塞率為46.9%。統(tǒng)計(jì)結(jié)果顯示栓塞術(shù)后AVM形狀集中,GKS治療前最大直徑≤3cm、GKS治療前體積≤6cm~3、GKS術(shù)后≥2年,聯(lián)合治療治愈率越高(P0.05)。結(jié)論:栓塞聯(lián)合GKS治療后顱窩AVM是一種有效的治療方法。針對(duì)性栓塞可以消除畸形團(tuán)中的薄弱環(huán)節(jié),能降低出血風(fēng)險(xiǎn);通過栓塞畸形供血?jiǎng)用}可以減小畸形團(tuán)的體積,提高GKS治療后畸形團(tuán)的閉塞率。
[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，

本文編號(hào)：2269930