Curative Embolization Of Cerebral Arteriovenous Malformation:a Clinical Study

Objective:Retrospective analysis of clinical data of embolization of cerebral arteriovenous malformation, to explore the influencing factors of Curative embolization of cerebral arteriovenous malformation (cAVM). Analysis the angioarchitecture Imagine before embolization, Spetzler-Martin scale, embolic agents selection, intraoperative surgical techniques and postoperative-related treatment measures; and on this basis, the experience about curative embolization of cAVM. Provide theoretical support and the accumulation of clinical experience for curative embolization of cerebral arteriovenous malformations, improve the curative rate of cAVM, reduce morbidity and mortality of embolization.Materials and methods:Between2008and2013, retrospective analysis of the total of40patients clinical data of embolization of cAVM. Clinical presentation included intracerebral hemorrhage (n=18), seizure (n=8), headache (n=7), neurologic deficits (n=5), and incidental finding (n=2). Carefully analysis the angioarchitecture Imagine before embolization, according to the S-M scale,10patients belonged to grade1,15belonged to grade Ⅱ,9belonged to grade Ⅲ,4belonged to grade Ⅳ, and2belonged to grade V.Then endovascular embolization of cAVM under general anesthesia. Take a series of related measures of introperative and postoperative, symptoms by patients before and afte embolization to improve the situation, image changes and complication for a period of3～6months, on this basis summed up the experience about curative embolization of cAVM. SPSS17.0software, P<0.05for the difference was significant.Reults:40cases of patients with cAVM embolizated. Patients underwent a total of64embolization sessions, with23having1session,10having2sessions,7having3sessions. Onyx injections from a single pedicle ranged from10to55minutes (mean,27minutes), and a single amount of Onyx injected ranged from0.9to12ml (mean, 5.2ml). After the embolization, angiography showed that complete occlusion of cAVM was achieved in22cases,80%-90%occlusion was obtained in10cases,60%～70%occlusion was seen in5cases, and about50%occlusion was found in3cases. Of the18cases having incomplete embolization, stereotactic radiotherapy was employed in2with excellent result. There were a total of10complications in this series, of which5were hemorrhagic,2were retrieving microcatheters, and3were ischemic. In our series,3cAVM with hemorrhagic occurred during catheter or guidewire manipulation, immediate injection of Onyx might be helpful to occlude the bleeding,2cases hemorrhagic occurred after return to ward attributable to normal perfusion pressure breakthrough (NPPB), of which1underwent decompressive craniectomy and aconservative treatment,1underwent aconservative treatment.2patients were retrieving microcatheters, of which1with t right temporal lobe cAVM patients appeared stick tube,and postoperative temporary left hemiplegia, Improved after treatment. The other cases of the hypothalamic basal ganglia area cAVM patients glue reflux into the middle cerebral artery, middle cerebral artery angiography showed significant stenosis slow blood flow, open brain artery stent expansion, this patient also stick tube, after temporary hemiplegia, improved after treatment,3were neurological dysfunction, of which2were fully restored after the appropriate treatment and1was permanent neurological dysfunction. No death occurred, in our Univariate test (x2test), S-M grade was associated with complete occlusion. The more S-M grade, the less complete occlusion rate. Statistical correlation analysis showed that the feeding artery number has a negative correlation with complete occlusion degree. The more feeding artery number, the less complete occlusion rate.Conclution:Number of feeding artery and drainage vein were correlated with embolization, the cAVM with singer or double feeding arteries and singer drainage vein could be cure embolization; Complete occlusion fits for grade Ⅰ～Ⅱ cerebral arteriovenons malformations and curative emboiotherapy with several times is suitable for grade Ⅲ～Ⅴ ones. Onyx is a suitable agent fo the treatment of cAVM with rather higher cure rate because of its diffuse controllable properties. Embolization of cerebral arteriovenous malformations can achieve excellent or good outcome, the complication is few but should be considerated. With our better understanding of cAVM and the continuous improvement of micro-catheter technology and embolic materials, mastering the operation skill and prevention of postoperative complication can get the higher cure rate in the treatment of cAVM.