Zhang Yunqiang,Wu Shuihua,Shen Chenfu,et al.Clinical analysis of transarterial embolization of cerebral arteriovenous malformations in children with oil plus Onyx glue[J].Journal of Clinical Pediatric Surgery,2025,(12):1163-1168.[doi:10.3760/cma.j.cn101785-202504046-013]
经动脉入路使用弹簧圈联合Onyx胶栓塞儿童脑动静脉畸形的临床分析
- Title:
- Clinical analysis of transarterial embolization of cerebral arteriovenous malformations in children with oil plus Onyx glue
- Keywords:
- Cerebral Arteriovenous Malformation; Embolization; Therapeutic; Transcatheter Arterial Embolization; Coil Onyx Glue; Child
- 摘要:
- 目的 初步探讨经动脉入路使用弹簧圈联合Onyx胶栓塞儿童脑动静脉畸形(cerebral arteriovenous malformation,cAVM)的临床效果与安全性。方法 回顾性分析郴州市第一人民医院小儿神经外科2020年1月至2024年8月采用弹簧圈联合Onyx胶栓塞治疗的30例儿童cAVM患儿临床资料。收集患儿手术前、手术后末次随访时脑血管畸形造影结果以及手术后并发症情况,并于术后6个月采用改良Rankin量表(modified Rankin scale,mRS)评价预后。结果 30例患儿Spetzler-Martin分级Ⅰ~Ⅱ级21例、Ⅲ级3例、Ⅳ~Ⅴ级6例,均成功完成弹簧圈联合Onyx胶栓塞治疗;其中Ⅰ~Ⅱ级21例于一次栓塞后病灶完全闭合;Ⅲ~Ⅴ级9例进行了二次栓塞。术后3个月影像学复查显示,24例(24/30,80%)畸形团未见显影,6例(6/30,20%)原病灶区域仍有少量残余畸形团显影(需进一步治疗)。术后并发出血2例、脑血管痉挛1例,均经保守治疗后症状缓解。随访6~12个月,改良mRS评分0分15例、1分13例、2分1例、3分1例。与文献报道单用Onyx胶栓塞率70%~78%、单纯弹簧圈栓塞率65%~75%相比,弹簧圈联合Onyx胶栓塞成功率明显升高,术后并发症发生率(10%比15%;10%比12.5%)和复发率(6.7%比17.5%;6.7%比14%)均明显降低。结论 使用弹簧圈联合Onyx胶栓塞治疗儿童cAVM,完全栓塞率高,并发症可控,预后良好。
- Abstract:
- Objective To explore the clinical effect and safety of transarterial embolization of cerebral arteriovenous malformation (cAVM) in children with coil and onyx glue. Methods From January 2020 to August 2024,the relevant clinical data were retrospectively reviewed for 30 children with cerebral arteriovenous malformations treated by coil embolization plus Onyx glue at First Municipal People’s Hospital.The angiographic results of cerebral vascular malformations and the related complications were collected before operation and at the last follow-up after operation.The outcomes were evaluated by modified Rankin Scale (MRS) at Month 6 after operation. Results Spetzler-Martin grade Ⅰ~Ⅱ (n=21),grade Ⅲ (n=3) and grade Ⅳ~Ⅴ (n=6) children were successfully managed with coil embolization plus Onyx glue with a success rate of 100%.Among them,21 cases (21/30,70%) of grade Ⅰ~Ⅱ were completely closed after one embolization; Nine patients (9/30,30%) with grade Ⅲ~Ⅴ underwent secondary embolization.At Month 3,imaging reexamination indicated that 24 cases (24/30,80%) had no development of malformation mass and 6 cases (6/30,20%) with a small amount of residual malformation mass in original lesion area required further treatment.The success rate of complete embolization was 80%.Postoperative complications of hemorrhage (n=2) and cerebral vasospasm (n=1) were relieved after conservative measures.The follow-up period was (6-12) month after discharge.The modified Mrs score was 0 (n=15),1 (n=13),2 (n=1) and 3 (n=1).According to the literature,complete embolization rate with Onyx glue alone was 74%,complication rate 15% and recurrence rate 12.5%; The complete embolization rate of coil was 67.5%,complication rate 12.5% and recurrence rate 14%.The success rate of coil plus Onyx glue embolization was significantly higher and postoperative complications (10% vs.15%; 10% vs.12.5%) and recurrence rate (6.7% vs.17.5%; 6.7% vs.14%) were significantly lower. Conclusions Using coil plus Onyx glue embolization for cerebral arteriovenous malformations in children has high complete embolization rate,controllable complications and decent prognoses.
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备注/Memo
收稿日期:2025-10-8。
基金项目:郴州市科学技术局科技发展计划项目(ZDYF2020078)
通讯作者:涂丽君,Email:511439643@qq.com