脳動静脈奇形に対する脳血管内手術におけるデバイス，塞栓物質の選択

Selection of Devices and Embolic Substances in Endovascular Surgery for Brain Arteriovenous Malformations

Point

・脳動静脈奇形に対する塞栓術での治療選択は治療目的を明らかにさせることから始まる．

・塞栓方法，塞栓物質を使い分けることによってより安全で効果的な塞栓を目指す．

・液体塞栓物質のplug ＆ push法の習得は脳動静脈奇形攻略の最重要ポイントである．

　Cerebral vascular surgery for cerebral arteriovenous malformations (cAVMs) is often challenging due to the diversity of lesions. I describe my treatment policy, embolization techniques, selection of embolic substances, and device choice.

　Proper use of embolization techniques is critical for safety in cAVM procedures. I use coils, NBCA, and Onyx. NBCA is employed when short-distance, reliable feeder occlusion is required. I prefer microcatheters with good contrast properties that are compatible with coils; for very thin feeders, I select microcatheter with a finer diameter. In cAVM embolization, “how to use” is more important than “what to use.” I define the purpose of embolization and select the technique and material for each case.