Clinical Analysis And Follow-up Study For Endovascular Treatment Of Cerebral Anteriovenous Malformations

Objective: In this study, we explore the possible influencing factors for embolization effects of cerebral arteriovenous malformation and the curative effect of pure endovascular therapy or embolization combined with stereotactic radiotherapy.Materials and methods: 55 cases with the clinical and imaging data and postoperative follow-up complete data of arteriovenous malformations collected from the first affiliated hospital of nanchang university neurosurgery inpatient, endovascular treatment of cerebral arteriovenous malformations November 2009 to November 2014.Including 39 males and 16 females. The max age of the patients is 63 years old, the mix one is 6 years old, and the mean age is 32.07 years old. Analyzed the therapeutic effect and the possible influencing factors(such as Spetzler-Martin grade, embolic material, AVM size, feeding aneries count), the effect of endovascular treatment, complications and the curative effect of embolization combined stereotactic radiotherapy.Results: Spetzler- MartinⅠgrade compared with other grade levels of cerebral AVM embolization degree have statistically difference(P<0.05).Onyx and Glubran on the degree of embolization of cerebral AVM was no statistically difference(P>0.05).In the small and medium-sized or large cerebral AVM,the embolization degree all have statistically difference(P<0.05). In the medium and large cerebral AVM,the embolization degree was no statistically difference(P>0.05).Between different feeding artery count of cerebral AVM,the embolization degree all have significant difference(P<0.05).Follow-up in hemorrhage, epilepsy, the clinical manifestations improved or disappeared after endovascular treatment were 100%;In headache or nerve dysfunction, they were 91.3% and 86.7%. In 55 patients, treatment-related complications occurred in 9 cases(16.4%). Including 3 cases of hemorrhage or cerebral edema, 4 cases of ischemic complications, 1 case of epilepsy, 1 glue tube. Only 1 patient suffered a permanent neurological deficit. 10 patients received stereotactic radiotherapy after endovascular intervention, and 7 patients came for DSA review. DSA revealed that 3 patients obtained complete obliteration, and 3 patients acquired nidus volume reduction, and nidus volume had not changed in 1 patient.Conclusions: 1. Onyx and Glubran were two kinds of ideal embolic materials in the endovascular treatment of cerebral AVM.2. For Spetzler- MartinⅠ, small, single feeding artery of cerebral AVM, endovascular treatment can obtain good therapeutic effect.3. Endovascular treatment was an important treatment for cerebral AVM because of good clinical effects and low complication rates.4. If pure endovascular treatment was difficult to obtain complete obliteration of AVM, embolization combined stereotactic radiotherapy would be a better choice.