Clinical Applied Study Of Endovascular Treatment With Onyx For Brain Arteriovenous Malformation

Objective:To evaluate the clinical and angioarchitectural indices of brain arteriovenous malformations(AVMs) to identity the main factors that were correlated With the presentation of hemorrhage. Then an equation that can predict the probability of hemorrhage can be created to help estimate and cure brain arteriovenous malformations (AVMs). On the basis of our experiences in endovascular intervention management with Onyx,and discusses the experience of embolizational skills,analysis of the causes and complications of interventional therapy for the treatment method,improve brain arteriovenous malformation clinical treatment level and effect.Methods:In the fist part, Review our department in January 2007 to December 2010 the medical records of diagnosis and treatment of 58 patients with complete data, analysis of imaging and clinical indices. Classity clinical, especially angioarchitectural indices of brain arteriovenous malformations (AVMs) and fined out their represents by means of collecting information of 58 cases to describe AVMs precisely and help estimate AVMs and guide management in clinical decision making.We analysis 19 indices of the brain arteriovenous malformations (AVMs) cases that include 5 clinical indices, and 12 angioarchitectural indices, and 2 classification indices of brain arteriovenous malformations (AVMs) using cluster analysis,Logistic regression and principal component analysis.In the second part In 21 patients before angiography conducted according to Spetzler-Martin grade, all patients under general anesthesia endovascular embolization. With the Onyx liquid embolic agent (Onyx-18) under surveillance in the DSA endovascular treatment. Symptoms by patients before and after embolization to improve the situation, image changes and complications for a period of 1 month to 2 year follow-up.Results:Using cluster analysis and principal component analysis,5 principal components were extracted that reflect size, location, feeding arteries, drainage system and morphological changes of vessels of AVMs.71.3% information of AVMs can be contributed with them. AVMs can be described and estimated by 5 lines.This method of classification was precise while includes fair much information and corresponds with clinical considerations.Location,origion of main feeding arteries,diameter and direction of main drainaging veins were introducted in the equation eventually. The location,origion of main feeding arteries,diameter and direction of main drainaging veins were the most important indices in predicting hemomrrhage.21 patients with Onyx embolization, a complete real-time embolization of cerebral angiography shows vascular malformation embolization group more than 80% in 6 cases,3 of them nearly full occlusion (immediately obvious contrast imaging AVM), range 50% -80% embolization in 12 cases,50% in 3 cases.There are 5 patients in the intraoperative or postoperative complications, intracranial bleeding complications in4 cases,1 case of intraoperative micro-guide wire to puncture malformation rupture, intraoperative real-time embolization treatment, the other 1 cases was returned to wards then caused cerebral hemorrhage. decompressive craniectomy were performed and cured by conservative treatment.1 with left temporal lobe AVM Patient appeared sticky pipe, and postoperative transiented right hemiplegia, complete recovery after treatment; 1 patient had secondary epilepsy, seizure control after treatment, follow-up 1 year epilepsy did not attack. Statistical correlation analysis showed that the Spetzler-Martin and Native grade has no correlation with the effects of endovascular treatment.Conclution:The precise equation can be created by collecting and studying lots of cases. It can be used to improve the estimation of risks, help guide management inclinical decision, make and improve the estimation of prognostication. This help avoid losses for lacking of experience. AVMs can be described and estimated by 5 lines which were location, feeding arteries, drainage system and morphological changes of vessels of AVMs. Onyx has a more efficient and more safety features, taken full advantage of Onyx application skills, and accumulated clinical experience can better play its embolization effectiveness. Based on the size and blood flow AVM, the number of feeding arteries, lesion location for individualized treatment plan options. Accurate preoperative assessment of patients, the application of intraoperative embolization techniques and prevention of postoperative complications,which are the key to improving efficacy.