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目的探讨α-氰基丙烯酸正丁酯(NBCA)分次栓塞治疗巨大脑动静脉畸形的安全性及疗效。方法17例巨大脑动静脉畸形患者均接受栓塞术前全脑血管造影检查,观察畸形血管团位置、供血动脉来源、静脉引流情况和总体动静脉循环时间,测量畸形血管团大小,进行Septzler分级,在数字减影血管造影监视下行NBCA分次栓塞治疗。结果17例巨大脑动静脉畸形经NBCA分次栓塞治疗后畸形血管团直径明显缩小,差异有高度统计学意义[(8.1±1.24)cmvs(2.3±0.45)cm,P<0.01]。1例患者接受3次治疗后2个月再次发生畸形血管团破裂出血而放弃治疗,2例患者术中并发脑血管痉挛,2例患者术中出现一过性眩晕、头痛,自然缓解。结论NBCA分次栓塞治疗巨大脑动静脉畸形安全、有效、并发症少,但彻底治愈巨大脑动静脉畸形,仍需结合栓塞后手术治疗或立体定向放射治疗。
Objective To investigate the safety and efficacy of fractional embolization of α-cyanoacrylate (NBCA) in the treatment of giant cerebral arteriovenous malformations. Methods Seventeen patients with giant cerebral arteriovenous malformations received embolization preoperatively with whole brain angiography. The position of malformation vessels, source of arterial blood supply, venous drainage, and total arteriovenous circulation time were observed. The size of malformation vessels was measured. Septzler grading, NBCA embolization was performed on digital subtraction angiography. Results The diameter of deformity vessels in 17 cases of giant cerebral arteriovenous malformations was significantly reduced after NBCA grafting ([8.1 ± 1.24] cm vs (2.3 ± 0.45) cm, P <0.01]. One patient underwent three cycles of treatment and then healed again with deformity of vascular rupture and bleeding. Two patients had intracranial cerebral vasospasm during operation, transient vertigo, headache and spontaneous remission occurred in two patients. Conclusion NBCA embolization for the treatment of giant cerebral arteriovenous malformations is safe, effective and has fewer complications. However, it is still necessary to combine surgical treatment after embolization or stereotactic radiotherapy to completely cure giant cerebral arteriovenous malformations.