Paladino J, Heinrich Z, Pirker N
Department of Neurosurgery, Clinical Hospital Centre, Zagreb, Croatia.
Surg Neurol. 1999 Feb;51(2):153-7. doi: 10.1016/s0090-3019(98)00045-7.
Arteriovenous malformations of Galen's vein are a rare type of vascular anomaly. The complex anatomy of these lesions creates an extremely difficult management dilemma. We report successful surgical treatment of a 7-year-old patient with a Galen's vein aneurysm.
A 7-year-old patient with slowly progressing gait disturbance, emotional instability, and strange behaviour is presented. A computed tomography scan revealed a high-density mass in the pineal region and cerebral angiography showed an aneurysm of Galen's vein. We decided to perform surgical excision of the aneurysm. The operation was performed under hypothermic circulatory arrest with barbiturate cerebral protection. The patient had no signs of postoperative ischemic deficits, hemorrhage, or neurologic deterioration.
Various techniques have been described for the obliteration of Galen's vein aneurysms, including direct surgical approach, staged operation, and transarterial, transvenous or transtorcular embolization. We present this patient to illustrate the use of hypothermic circulatory arrest and barbiturate cerebral protection for successful surgical excision of this complex vascular lesion. The combination of these techniques allowed us, in this case, to operate with reasonable safety on otherwise, difficult to treat aneurysm of Galen's vein.
大脑大静脉动静脉畸形是一种罕见的血管异常类型。这些病变复杂的解剖结构造成了极其困难的治疗困境。我们报告了一名7岁大脑大静脉动脉瘤患者的成功手术治疗。
本文介绍了一名7岁患者，其步态障碍进展缓慢、情绪不稳定且行为怪异。计算机断层扫描显示松果体区有高密度肿块，脑血管造影显示大脑大静脉动脉瘤。我们决定对该动脉瘤进行手术切除。手术在低温循环停止并采用巴比妥类药物脑保护的情况下进行。患者术后无缺血性缺损、出血或神经功能恶化的迹象。
已经描述了多种用于闭塞大脑大静脉动脉瘤的技术，包括直接手术入路、分期手术以及经动脉、经静脉或经窦栓塞。我们展示该病例是为了说明使用低温循环停止和巴比妥类药物脑保护成功手术切除这种复杂血管病变的情况。在本病例中，这些技术的联合应用使我们能够在相对安全的情况下对原本难以治疗的大脑大静脉动脉瘤进行手术。
