脑动静脉畸形栓塞影响（脑动静脉畸形栓塞并发症因素分析）

栓塞治疗是目前治疗脑动静脉畸形的重要手段，尽管其手术创伤小，但仍有一定的并发症发生率，究竟哪些因素导致出现并发症呢，或者说哪些情况更容易出现并发症呢？这里摘译AJNR 2014年发表的一篇文章以飨读者。

【目的】介入栓塞治疗是脑动静脉畸形治疗的重要手段之一。然而，栓塞手术后并发症的相关因素鲜有报道。作者回顾性分析幕上脑动静脉畸形血管构筑特点，探讨可能与栓塞手术并发症和不良预后有关的因素。

BACKGROUNDAND PURPOSE: Embolization is an important therapeutic technique in brain arteriovenousmalformations; however, little has been reported on the factors contributing tocomplications. We retrospectively reviewed a large series of supratentorialbrain AVMs to identify the angioarchitectural characteristics that might beassociated with the complications of embolization and poor clinical outcomes.

【方法】回顾性分析了2005年-2008年间利用ONYX栓塞治疗的130例幕上脑动静脉畸形的临床资料和血管构筑特点。将并发症分为一过性神经功能障碍、永久性并发症和死亡。利用单因素和多因素分析评价有或无并发症患者的血管构筑特点。

MATERIALS AND METHODS: The clinical andangiographic features of 130 consecutive patients with supratentorial brainAVMs embolized with ethylene-vinyl alcohol copolymer in our hospital from2005–2008 were retrospectively reviewed. None of these patients had priorembolization. Complications were classified as transient neurologic deficits,persistent neurologic deficits, and death. Univariate and multivariate analyseswere conducted to assess the angiographic features in patients with and withoutcomplications.

【结果】130例患者中共23例出现栓塞相关并发症，其中一过性神经功能障碍13例（10%，9例缺血和4例出血），永久性神经功能障碍9例（6.92%，7例缺血和2例出血），死亡1例。单因素分析提示AVM位于功能区和单独深静脉引流与栓塞后并发症相关。多因素分析同样提示功能区（P=0.001）和单独深静脉引流（P=0.035）与并发症密切相关。AVM位于功能区主要导致永久性缺血性神经功能障碍；静脉引流闭塞与部分或次全栓塞术后围手术期出血密切相关。

RESULTS: Twenty-three complicationsoccurred in 130 embolization procedures, 13 (10%) were transient neurologicdeficits (9 ischemic and 4 hemorrhagic), 9 (6.92%) were persistent neurologicdeficits (7 ischemic and 2 hemorrhagic), and 1 death occurred. By univariate analyses,eloquent cortex (OR, 2.57; 95% CI, 1.08–3.42) and exclusive deep venousdrainage (OR, 4.56; 95% CI, 1.28–9.67) were correlated with proceduralcomplications. The impaction of eloquent cortical location (P=0.001) andexclusive deep venous drainage (P=0.035) on complications were alsodemonstrated by multivariate analysis. Eloquent cortex mainly resulted inpermanent ischemic neurologic deficit; occlusion of drainage vein wassignificantly correlated with periprocedural hemorrhage in supratentorial brainAVMs with subtotal and partial embolization.

【结论】通过回顾性分析首次进行栓塞治疗的幕上脑动静脉畸形，永久性并发症和死亡的发生率为6.92%。AVM位于功能区和单独深静脉引流与并发症的发生密切相关。

CONCLUSIONS: In aretrospective study on supratentorial brain AVMs with first-time embolization,6.92% of patients had permanent neurologic deficit or death. Eloquent corticallocation and exclusive deep venous drainage were associated with complications.

附主要结果