Effective Research Of Interventional Therapy In Spetzler-Martin Grade Ⅳ-Ⅴ Brain Arteriovenous Malformation

Objective:Retrospectivly analysis the DSA appearances and clinical data of 78 cases AVM before and after treatment, according to Spetzler-Martin grading standards and explore the DSA appearances and interventional therapy effective of Spetzler-Marti Grade IV-V AVM.Methods:1. Collect 78 cases of AVM inpatients from June,2005 to June,2010 for this study; all cases were confirmed by DSA or pathology. During those patients, 36 cases were Spetzler-Marti Grade Ⅵ-Ⅴ, which were perfomed with interven-tional embolization; in the the controls,42 inpatients suffered from petzler-Marti Grade Ⅱ-Ⅲ intracranial Arteriovenous Malformation were choose, which were perfomed with surgical operation.2. Diagnosis and grading of intracranial AVM standard reference Peking Union Medical College in China in 2005 published "Clinical Vascular Therapy" and the 1986 European Neurosurgery (Neurosurg,1986) published by the Spetzler-Martin grading.3. In the observation group, all inpatients were perfomed with interven-tional embolization (Philips Ingegris, V5000), Embolic agent was the surgical glue (NBCA, ev3 Company); in the controls, all inpatients were perfomed with surgical operation; All cases routine postoperative review DSA or CT, MRA and three months to two years of follow-up.4. Comparative analysis the DSA differences of those patients before and after treatment, including the rate of embolization,the number of feeding artery, the changes of angioarchitecture and the conditions of hemorrhages.5. Comparative analysis of clinical performance before and after treatment, including the main AVM clinical symptoms:epilepsy, hemorrhage, headaches, nervous disorders and complications.6. Application of SPSS 13.0 to analysis data. The rate was used to expesse relative number; the X2 test was used to expesse the differences among groups. If P<0.05,the outcome have statistically significant.Results:1. There were 36 cases AVM accord with Spetzler-Marti Grade Ⅵ-Ⅴ; which were perfomed with interventional embolization. The chief expression of embolization:① the shrinking lession,5 of 36 patients embolic rate was from 80% to 90%; 20 cases of embolic rate was from 70% to 80%; 4 cases of embolic rate was from 60% to 70%; 3 cases of embolic rate was from 20% to 50%.② the reduce of feeding artery, there were 76 feeding arteries were perfomed embolization. After embolization,58 feeding arteries lost power. ③the changes of angioarchitecture, there were 3 cases of Aneurysm that were completely occluded. ④ The changes hemorrhages, after embolization,7 cases of lession show cessation from or slowing of hemorrhages.In the controls,30 of 42 patients embolic rate was from 90% to 100%; 6 cases of embolic rate was from 80% to 90%; 3 cases of embolic rate was from 70% to 80%; 3 cases of embolic rate was from 60% to 70%.2. Before the embolization, the total score of lessions are 158 points, according to Spetzler-Martin grading standards; after the first embolization, there are 68 points; after the second embolization,55 points left; after the last embolization, the total score of lessions are 46 points3. In this study,77.7% of those patients had their symptoms marked improved; 4 patients, accounting for 11.1% of the total, had no significant improvement of symptoms; the condition of 4 patients grew worse, accounting for 11.1% of the total; In the controls,47.6% of those patients had their symptoms marked improved; 16 patients, accounting for 38.0% of the total, had no significant improvement of symptoms; the condition of 6 patients grew worse, accounting for 14.2% of the total. There were significant differences between the two teams (P<0.05); The clinical efficacy indicate that its effectiveness is superior to the controls.The rate of complication related to the embolization was 4.8%; the rate of mutilation was 2.7%; one patient lost his life in 2 weeks after treatment. In the controls, The rate of complication related to the embolization was 26.2%; the rate of mutilation was 11.9%; 6 case inpatients accord with Spetzler-Marti Grade Ⅲ, the nerve condition of 6 patients grew worse, one patient lost his life in 1 weeks after treatment.Conclusion:Interventional therapy can reduce the size of most lesions and gradually correct the abnormal hemodynamics; Most patients have a significant improvement of clinical symptoms. Interventional therapy is a safe and effective treatment for Spetzler-Marti Grade Ⅵ-Ⅴ intracranial Arteriovenous Malformation.