| Research background:Cerebral arteriovenous malformations(cAVM)are composed of three parts:supply artery,malformed blood vessel mass and drainage vein,and lack of normal capillary bed.It is one of the main causes of subarachnoid hemorrhage following intracranial aneurysms.The annual hemorrhage rate is about 2%-4%,and the rebleeding rate of ruptured cAVM increases significantly.With the continuous development of interventional radiology technology,the effect of interventional therapy has been greatly improved,and it has become one of the main treatment methods of cAVM.Glubran glue,as a first-line embolic agent is widely used in the treatment of cAVM.The concentration of Glubran glue is closely related to the therapeutic effect and the occurrence of surgical complications.However,at present,the choice of Glubran glue concentration mainly depends on the clinical experience of the surgeon,which makes it difficult for clinicians with less experience to master and apply Glubran glue.The purpose of this study was to explore the relationship between the concentration of Glubran glue and embolization effect,and to provide evidence for clinical treatment,so as to improve the efficacy and safety of Glubran glue in the treatment of cAVM.Part I Clinical characteristics of cerebral arteriovenous malformationsObjective:To summarize and analyze the clinical characteristics of cAVM,such as symptoms,location,age and gender,and to improve the understanding of the disease.Methods:The clinical data of 976 patients with cAVM,including symptoms,location,age and sex,were analyzed retrospectively..Results:976 patients with cAVM were 645 males and 331 females.The average age of onset was 30 ±15.3 years.Temporal,parietal and occipital lobes were the most common sites.Headache and epilepsy are the most common clinical manifestations.Single-branch drainage and small cAVM are at higher risk of bleeding.78%of cAVM patients with hemangioma have cerebral hemorrhage;Superficial,large cAVM is more likely to have secondary epilepsy.Of 437 patients who underwent cAVM embolization,41 had operation-related microhemorrhage and no severe complications such as pulmonary embolism and death.Conclusion:The direction of drainage and the size of malformations are closely related to the rupture and bleeding of cAVM.The risk of bleeding increases in patients with hemangioma.Superficial and large cAVM are often the main risk factors for secondary epilepsy,and interventional embolization for cAVM is safe.Part II Selection of Glubran Glue Concentration in Embolization of Cerebral Arteriovenous MalformationsObjective:The aim of this study was to determine the relationship between the concentration of Glubran glue and embolization effect,and to provide evidence for clinical treatment.Methods:The arteriovenous circulation time of "embolization unit" was defined by dynamic image of microcatheter superselective angiography.The Image-Pro Plus image processing software was used to calculate the ratio of the area of the cast after embolization to the area of the malformed mass before embolization,and the proportion of the cast after embolization was obtained.DSA dynamic images during embolization were observed to determine the dispersion of Glubran glue.According to the time of arteriovenous circulation,the case data were divided into three treatment time groups<2s,2s-4s and>4s.Each time group was divided into different subgroups according to different glue concentration.The subgroups in each group were compared with each other,and the effects of embolic casting with different concentration in each group were studied.Using SPSS 20.0 statistical software,312 patients were treated with Glubran glue 559 times during embolization.The data of arteriovenous circulation time,Glubran glue concentration,dispersion and casting proportion were analyzed and concluded.Result:CAVM arteriovenous circulation time<2S group,2s-4s group and>4S group accounted for 13%,77%and 10%respectively;20%-33%was the most common glue concentration;the operation-related bleeding rate was about 8.5%,all of which were micro-bleeding,without serious complications such as pulmonary embolism and death.Conclusion:GLubran glue is a safe embolic agent for the treatment of cAVM.The choice of concentration depends mainly on the time of arteriovenous circulation of cAVM.50%Glubran glue concentration in<2S group was better than other Glubran glue concentration;the most suitable glue concentration in<4S group was about 20%.The most suitable glue concentration in 2s-4s group was between 25%and 33%. |
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