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目的探讨与颅内动静脉畸形(AVM)血流相关的动脉瘤血管内治疗的效果。方法回顾性分析20例AVM患者的临床资料。采用Seldinger技术,在栓塞20个动脉瘤的同时,栓塞全部或部分畸形血管团,对残余部分畸形血管团,按计划分期进行再次栓塞治疗(9例)或进行放射治疗(3例)。分析DSA结果及血管内治疗动脉瘤的效果。结果20例与动静脉畸形血流相关的动脉瘤患者中,有18例Spetzler分级在Ⅲ级以上。共发现与颅内动静脉畸形血流相关的动脉瘤22个,其中位于畸形血管团内11个,基底动脉末端2个,病灶同侧颈内动脉C1段2个,后交通动脉起始部3个,供血动脉段4个。共栓塞了20个动脉瘤,其中使用弹簧圈栓塞5个动脉瘤,11个畸形血管团内动脉瘤及供血动脉上的4个动脉瘤,均以Onyx及Glubran胶进行栓塞。颈内动脉C1段及后交通动脉起始部的2个小宽颈动脉瘤未予处理,现尚在随访中。脑血管造影随访9例,随访时间为1.5～13.0个月,9例再次进行残余畸形血管团栓塞时,见动脉瘤栓塞致密,症状较术前改善。3例残留较少的病例术后进行了伽玛刀放射治疗。结论与颅内动静脉畸形血流相关的动脉瘤多见于中、大型血管畸形,血管内治疗是安全、有效的方法。
Objective To investigate the effect of endovascular treatment of aneurysms associated with intracranial arteriovenous malformation (AVM) blood flow. Methods The clinical data of 20 patients with AVM were retrospectively analyzed. Seldinger technique was used to embolize all or part of the aneurysm while embolization of all or part of the vascular group, the residual part of the abnormal vascular group, according to the planned re-embolization (9 cases) or radiotherapy (3 cases). Analysis of DSA results and endovascular treatment of aneurysms. Results Among 20 aneurysms associated with arteriovenous malformation aneurysm, 18 Spetzler grading was above grade III. A total of 22 aneurysms associated with intracranial arteriovenous malformations were found, of which 11 were located in the abnormal vascular group, 2 at the terminal of the basilar artery, 2 at the C1 segment of the ipsilateral internal carotid artery, 3 at the beginning of the posterior communicating artery A, 4 arterial blood supply. A total of 20 aneurysms were embolized, including 5 aneurysms embolized with coils, 11 aneurysms with abnormal blood vessels, and 4 aneurysms on the donor arteries, all of which were embolized with Onyx and Glubran gum. Two small wide-necked aneurysms of the C1 segment of the internal carotid artery and the posterior communicating artery were not treated and are still under follow-up. Cerebral angiography was followed up for 9 cases. The follow-up time ranged from 1.5 to 13.0 months. In 9 cases with residual malformation vessel embolization, aneurysm embolism was dense and the symptoms improved compared with that before operation. Three patients with fewer residual cases underwent gamma knife radiotherapy. Conclusion The intracranial arteriovenous malformation aneurysm associated with blood flow more common in large and medium vascular deformities, endovascular treatment is a safe and effective method.