Brain Arteriovenous Malformation: Angioarchitecture Imaging And Endovascular Treatment With Onyx

Objective:To restrospectively analyse the imaging data of CT,MRI,CTA,MRA,2D-DSA and 3D-DSA on brain arteriovenous malformation.To summarize diagnosis significance of variable methods on angioarchitecture and its relation to circum-structure for selecting management methods. On the basis of our experiences in endovascular intervention management with Onyx,and discusses the experience of embolizational skills,analysis of the causes and complications of interventional therapy for the treatment method,improve brain arteriovenous malformation clinical treatment level and effect.Methods: Review our department in July 2007 to March 2010 the medical records of diagnosis and treatment of 23 patients with complete data, analysis of imaging, of which 9 patients underwent CTA and DSA, and other 9 patients underwent MRA and DSA in the size of AVM patients statistical analysis, paired t test using statistical methods,and on the feeding artery shows the number of cases use consistent rate analysis. In 23 patients before angiography conducted according to Spetzler-Martin grade, all patients under general anesthesia endovascular embolization. With the Onyx liquid embolic agent (Onyx-18) under surveillance in the DSA endovascular treatment, according to DSA images assess of size and the feeding artery of AVM,and compared with embolization range using correlation analysis. Symptoms by patients before and after embolization to improve the situation, image changes and complications for a period of 1 month to 2 year follow-up.Results: Conducted on 23 patients imaging data analysis, enhanced CT scan of all rows are diagnosed in patients with brain AVM, of which 9 cases of patients CTA and DSA, measured the size of AVM analysis showed that there was significant difference between the two, CTA measurement of deformity group is less than DSA.Other 9 cases of patients MRA and DSA, measured the size of AVM analysis showed that there was significant difference between the two, MRA measurement of deformity group is less than DSA. In the display of the supplying artery, CTA compared with DSA and displays a consistent rate of 67%, MRA compared with DSA was 89% of its demonstrated compliance. 23 patients with Onyx embolization, a complete real-time embolization of cerebral angiography shows vascular malformation embolization group more than 80% in 4 cases, 2 of them nearly full occlusion (immediately obvious contrast imaging AVM), range 50% -80% embolization in 16 cases, 50% in 3 cases. There are 5 patients in the intraoperative or postoperative complications, intracranial bleeding complications in 3 cases, 1 case of intraoperative micro-guide wire to puncture malformation rupture, intraoperative real-time embolization treatment, the other 2 cases were returned to wards and later blood pressure, normal perfusion pressure breakthrough caused by cerebral hemorrhage, decompressive craniectomy were performed and cured by conservative treatment. 1 with left temporal lobe AVM Patient appeared sticky pipe, and postoperative transiented right hemiplegia, complete recovery after treatment; 1 patient had secondary epilepsy, seizure control after treatment, follow-up 1 year epilepsy did not attack. Statistical correlation analysis showed that the feeding artery number or a Spetzler-Martin grade has a negative correlation between embolization,the more the artery,the less range of embolization, Spetzler-Martin grade higher in one embolism less range. Spetzler-Martin grading further statistical analysis showed that the size of AVM and embolization has a negative correlation, the greater the AVM, embolization of the scope of a smaller, but whether in the functional areas or deep venous drainage was not correlation with the effects of embolization.Conclution: The diagnosis value of evaluating in medical imaging including CT,MRI,CTA,MRA and DSA on angioarchitecture imaging and its relation to circum-structure of AVM has advantage and disadvantage itself,which has a guidance for selecting a treatment role. Selective catheterization angiography can confirm the diagnosis of brain AVM and provide quality-oriented means of intervention. Onyx has a more efficient and more safety features, taken full advantage of Onyx application skills, and accumulated clinical experience can better play its embolization effectiveness. Based on the size and blood flow AVM, the number of feeding arteries, lesion location for individualized treatment plan options. Accurate preoperative assessment of patients, the application of intraoperative embolization techniques and prevention of postoperative complications,which are the key to improving efficacy.