| BackgroundCerebral arteriovenous malformation is the most common cerebral vascular dysplasia due to the lack of normal capillary bed. Angiographically, AVM is characterized by the performance of feeding arteries expansion and draining veins distorted mutual interlaced closely together clumps. It is characterized by abnormal arteriovenous shunt the angiographical early developing of lesion draining veins.Its main symptoms are the onset of bleeding, epilepsy, headache and other focal neurological dysfunction. Brown RD reported that the first symptom was bleeding. Among them, the most symptoms was bleeding in brain tissue, the2nd was subarachnoid hemorrhage, and the remaining was intraventricular hemorrhage or mixture of bleeding. C Stapf had the retrospective study of brain arteriovenous malformation at the New York population of8.9million from1996to1999. He found that the1st diagnosed cerebral arteriovenous malformation cases were accounted for33%of all patients. Foster et al found that, once the bleeding lesions, the cAVM is prone to bleeding again due to lesions vascular structure in an unstable state, In this study, we retrospective collected the large number of cAVM cases from 2001-1to2012-1in Zhujiang Hospital and make the statistical analysis on the risk factors of intracranial hemorrhage after embolization of cerebral arteriovenous malformation, and evaluated the therapeutic efficacy using different sembolism materials for the purpose of guiding the clinical prevention and treatment decision making in the future.The first chapterFactors of cerebral arteriovenous malformation hemorrhageBackgroundThe most serious and the most common symptoms of Cerebral AVM is intracranial hemorrhage. There are many kind of reasons for cerebral arteriovenous malformation hemorrhage, which may be related to age, sex, hypertension, high cholesterol, high blood sugar, angioarchitecture factors associated with vascularfactors deformity, the size of the feeding artery of the source, quantity, level of distortion, the diameter of the blood supply to the way the location of the malformation, size, shape, number of draining veins diameter, drainage, drainage path, whether accompanied by hemangiomas, and so on. However, there is lack of systematic research and analysis. It is necessary to the full depth study on brain AVM hemorrhage risk factors.ObjectionTo Investigate the clinical and angioarchitecture relevant factors of cerebral arteriovenous malformation hemorrhage.Methods and materials312patients with arteriovenous malformations were diagnosed in Zhujiang Hospital, nearly ten years with complete clinical data and imaging data.168cases in hemorrhage group (case group), male86case, female82cases, age range from12to68years old.144cases in non-cerebral hemorrhage group (control group, patients with epilepsy, headache, nerve function missing for the onset of symptoms), male81cases, female63cases, range from8to71years old,. There were compared between the two groups clinically relevant risk factors of age, gender, hypertension, high cholesterol, high blood sugar, pregnancy and angioarchitecture risk factors associated with AVM location, size, shape, type of feeding artery, draining vein type, accompanied by aneurysm differences,and then using logistic regression analysis of the relationship between the above factors with brain AVM bleeding, summarizes the major risk factors and protective factors for cerebral AVM hemorrhage.ResultsAVM diameter is≧6cm (OR2.006,95%CI1.286-3.128), deep venous drainage (OR1.679,95%CI1.146-2.460), single venous drainage (OR3.684,95%CI2.554-5.315) indeep (OR2.372,95%CI1.175-4.787), with high blood pressure (OR3.433,95%CI1.812-6.503) were risk factors for cerebral arteriovenous malformation hemorrhage.ConclusionLarge and Deep-seated AVM and cAVM with the single deep venous drainage were the independent risk factors of cerebral AVM hemorrhage. The second chapterEndovascular embolization of Cerebral artcriovenous malformationsBackgroundThere were four kinds of treatment strategies for cerebral arteriovenous malformation:Surgery, endovascular treatment, radiation therapy and conservative treatment, which can be used alone or combined with each other. With the extensive use of the novel intravascular embolic agent like onyx and Glubran with a wonderful therapeutic effect, endovascular embolization has increasingly become the main treatment of cerebral arteriovenous malformations.ObjectionTo investigate the efficacy, advantages and disadvantages between onyx and Glubran in the treatment of brain arteriovenous malformation in different classification.Method138cases with arteriovenous malformations Selected from Zhujiang Hospital neurosurgery inpatient, interventional treatment of brain arteriovenous malfomatoin January2006.1to January2012.1.78cases with Glubran embolization in the treatment group, total of146times embolism.60patients with ONYX embolization,112times embolism.86male,52female, age range from8to67years old, an average of36.5years. Recalling the analysis of hospitalization records, surgical records,cerebral angiography (including follow-up angiography), analysis comparing ONYX and different Glubran embolism and treatment effects, complications.Results Complete occlusion rate was similar tin both of Glubran and Onyx.29%was in Onyx group and31%in glubran group with no significant difference. Subtotal occlusion rate was simple and small in both of them, the blood supply to the type of arteriovenous malformations can achieve better occlusion The therapeutic effect of graded higher blood supply with the complex arteriovenous malformation was similar in both group. The stick tube complication in Onyx group was higher than in Glubran group.ConclusionOnyx and glubran had the same cure rate in the treatment of cerebral AVM. Both of them can be facultative. |
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