| Objection: Cerebral arteriovenous malformation(AVM)represents a rare disease of the central nervous system characterized by arteriovenous shunts in which one or more arterial pedicles enter the vascular lesion,creating early drainage in the venous outflow channel.These lesions are considered congenital and can cause clinical concerns in a variety of ways,such as seizures,intracranial hemorrhage,chronic headache,or progressive neurological deficits.At present,arteriovenous malformation(AVM)is mainly treated by craniotomy,which has high operational risk and high disability.In recent years,with the continuous improvement of neurointerventional techniques,fractional transcatheter arterial embolization(f TAE)can be used to treat AVM rather than surgical treatment.However,its effectiveness in treating AVM has never been explored.The aim of this study was to investigate the use of fractional endovascular interventional embolization for the treatment of AVM and to explore its complications and long-term prognosis.This study provides a theoretical and practical basis for improving the efficacy of f AVM.Methods:The research method used in this study is a retrospective analysis study,which collected 115 AVM patients who were hospitalized from the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2018.Patients were divided into two groups according to different treatment methods: f TAE treatment group,a total of 58 patients;minimally invasive craniotomy(MIC)treatment group,a total of 57 patients.All available data showed that all patients and their families had a detailed understanding of the risk of treatment with f TAE and MIC,and signed informed consent.The clinical data and follow-up data of the two groups were retrospectively analyzed to compare the effectiveness,recurrence risk and complications of the two treatment methods including headache,epilepsy,decreased limb muscle strength,decreased limb sensation,and early visual field defects.Result:In the f TAE group,45 patients were completely embolized,and the complete embolization rate was 77.5%;13 patients with AVM residuals below 20%.DSA review in the MIC group indicated complete resection.Postoperative complications analysis showed that:(1)The early limb strength of the f TAE group was lower than that of the previous 9 patients(P=0.001),6 patients recovered after rehabilitation exercise(P=0.039);7 patients with early limb sensation decreased after operation(P=0.003),5 patients recovered completely after rehabilitation exercise(P=0.047);3 patients had early visual field defect after operation(P=0.025),and 1 patients recovered after rehabilitation(P=0.653).In the MIC group,the early limb muscle strength decreased by 19 people,and 8 people recovered after rehabilitation exercise.In the early postoperative period,the limbs decreased by 16 people,and 7 people recovered completely after rehabilitation.There were 8 patients with early visual field defect after operation,and 3 patients recovered after rehabilitation.(2)There were 48 patients with headache before embolization in f TAE group,40 patients improved after operation(P=0.012);41 patients had headache before embolization in MIC group,and 27 patients improved after operation.(3)20 patients with epilepsy before embolization in f TAE group,16 patients improved after operation(P=0.952);18 patients with epilepsy before embolization in MIC group,14 patients improved after operation.After one year of follow-up,the rate of rebleeding was 2 in the former and 0 in the latter,P=0.000.Regression analysis suggests that residual AVM is a major factor in rebleeding.Conclusion: The results of this study demonstrate that f TAE in patients with AVM is better than MIC in improving postoperative early limb muscle strength,decreased limb sensation,and pre-embolic headache,but does not reduce visual field defect recovery rate and epileptic seizure rate.In addition,f TAE rebleeding rate is higher than the MIC. |
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