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目的观察血管内栓塞治疗颅颌面高流量血管畸形的疗效。方法颅颌面高流量血管畸形患者共9例。手术前全部经CT、MRI、Dopplar超声和DSA血管造影明确诊断。栓塞材料采用PVA颗粒,直径为250～350μm。经血管内导管(微导管)注入畸形血管团。结果本组9例病人,一次完全栓塞者6例,其余3例均经过2次治疗达到完全栓塞。除1例失随访外,其余8例获随访。原有的症状体征基本消失,局部外形未发生进一步改变。9例患者栓塞后均未出现局部皮肤黏膜和牙周组织的缺血和坏死。4例(最长45个月,最短4个月后)经DSA动脉造影复查,未发现动静脉畸形血管团显影,经栓塞的动脉均保持通畅。但是,原病灶组织周围出现较多新生血管;同时,在毛细血管期有原病灶的异常引流静脉显影,但其循环时间接近正常血液循环时间。对1例随访时间最长的病人进行局部定位穿刺,在异常引流静脉内植入游离弹簧圈栓塞,术后无任何局部并发症。结论根据颅颌面高流量血管畸形的供应动脉、异常血管网团和引流静脉的特点,采用PVA颗粒作为栓塞材料,完全能够达到使异常血管网团闭塞的目的,同时具有易于控制栓塞过程,避免误栓正常血管的优点。
Objective To observe the effect of endovascular embolization on craniomaxillofacial high-flow vascular malformations. Methods A total of 9 patients with craniomaxillofacial high-flow vascular malformations. All preoperative CT, MRI, Dopplar ultrasound and DSA angiography a clear diagnosis. Embolization material using PVA particles, a diameter of 250 ~ 350μm. Intravascular catheter (microcatheter) into the abnormal vascular groups. Results The group of 9 patients, a complete embolism in 6 cases, the remaining 3 cases were treated twice to achieve complete embolization. Except 1 case of missed follow-up, the remaining 8 cases were followed up. The original symptoms and signs disappeared, the local shape did not change further. None of the 9 patients had ischemia and necrosis of the local skin mucosa and periodontal tissue after embolization. 4 cases (up to 45 months, the shortest 4 months after) DSA angiography review, found no vascular imaging of arteriovenous malformations, embolization of the artery were unobstructed. However, there were more neovascularization around the original lesion tissue. In the meantime, there was anomalous drainage of the original lesion during the capillary phase, but the circulation time was close to the normal blood circulation time. One patient with the longest follow-up time was localized puncture, and a free coil embolization was implanted in the abnormally drained vein without any local complications. Conclusion According to the features of supplying artery, abnormal vascular network and drainage veins of craniomaxillofacial high-flow vascular malformations, PVA particles can be used as embolization material to completely occlude the abnormal vascular network, and it is easy to control the embolization process and avoid The advantages of mishandling normal blood vessels.