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目的 观察血管内栓塞联合γ刀治疗脑动静脉畸形(AVM)的治疗效果及适应症和并发症。方法选择2000年9月～2002年10月住院的21例脑动静脉畸形患者施行血管内栓塞联合γ刀治疗,先应用二氰基丙烯酸异丁酯(Bucrylate,NBCA)栓塞脑动静脉畸形,使体积缩小。对血液速度快、体积较大者,采取分次逐步栓塞。在最后1次栓塞3～5天后行γ刀治疗,在MRI定位下确定AVM的大小和边界,根据病灶大小、部位和类型设计照射的靶点位置、靶点个数、周边剂量、中心剂量和剂量曲线。结果 脑AVM完全闭塞者12例,闭塞率57.1％,病灶明显缩小6例(28.6％),病灶大小无变化3例(14.3％),术后脑AVM出血1例,无死亡病例。结论血管内栓塞联合γ刀治疗脑AVM是一种安全有效的新手段,尤其适合于大～巨大型脑AVM、脑深部AVM或功能区、复杂AVM以及手术难度大、不能耐受开颅手术的患者。具有创伤小、住院时间短优点,费用高是其缺点。
Objective To observe the therapeutic effect, indications and complications of intravascular embolization combined with gamma knife in the treatment of cerebral arteriovenous malformations (AVM). Methods Twenty-one patients with cerebral arteriovenous malformation who were hospitalized from September 2000 to October 2002 were treated with endovascular embolization combined with gamma knife. The cerebral arteriovenous malformations were embolized with Bucrylate (NBCA) Volume reduced. On the blood speed, the larger volume, take a gradual embolization. Gamma knife treatment was performed 3 to 5 days after the last embolization. The size and boundary of AVM were determined under MRI localization. The location of target site, target number, peripheral dose, central dose and Dose curve. Results The complete occlusion of brain AVM was found in 12 cases. The occlusion rate was 57.1%. The lesions were significantly reduced in 6 cases (28.6%), the size of the lesion was unchanged in 3 cases (14.3%), and the postoperative AVM hemorrhage occurred in 1 case without death. Conclusions Endovascular embolization and γ knife treatment of brain AVM is a safe and effective new method, especially suitable for large ~ huge AVM, deep brain AVM or functional areas, complex AVM and difficult operation, can not tolerate craniotomy patient. With less trauma, shorter hospital stay, the high cost is its disadvantage.