Nishiura T, Nishida A, Handa A, Gotoh M, Tsuno K, Ishimitsu H
Department of Neurosurgery, Iwakuni National Hospital, Japan.
No Shinkei Geka. 1999 Oct;27(10):895-901.
Arteriovenous malformation (AVM) of the scalp is uncommon, and a subtype which has connection with the intracranial dural sinus is extremely rare. Only 3 cases have been reported. We present a case of congenital AVM of the scalp which was connected with the intracranial venous sinus. A 27-year-old woman had been noted as having a pulsatile soft mass in the midline of the occipital region since her birth. She visited our hospital because of pain and enlargement of the mass. The patient had had no history of trauma. Physical examination revealed a pulsatile scalp mass in the midline of the occipital region, measuring 3.5 x 3.5 x 1 cm. A loud bruit was ausculated. Tenderness was noted. The skin over the mass was slightly reddish. No focal neurological deficits were noted. Plain skull films demonstrated a round defect in the midline of the occipital bone. Magnetic resonance imaging (MRI) demonstrated a subcutaneous mass with low signal intensity and an infratentorial mass with flow void. 3D CT angiograms demonstrated a subcutaneous vascular mass with a single large vein draining into the right transverse sinus. External carotid angiograms revealed a vascular lesion within the scalp with supply from the branches of the bilateral occipital arteries and the meningeal arteries. The nidus penetrated the skull and connected to a dilated varix, which had a draining vein shunting into the right transverse sinus. After embolization of the right meningeal feeding arteries, surgery was performed. The vascular lesion penetrated the skull and the dura. The infratentorial mass was in the epiarachnoid space and was fed by a small pial artery. The mass was excised completely after interruption of the pial artery and the draining vein. Postoperative course was uneventful. Histologically, the subcutaneous mass and infratentorial vascular mass were shown to be AVM and varix, respectively.
头皮动静脉畸形（AVM）并不常见，而与颅内硬脑膜窦相连的亚型极为罕见。仅报道过3例。我们报告1例先天性头皮AVM与颅内静脉窦相连的病例。一名27岁女性自出生起枕部中线就有一个搏动性软肿块。她因肿块疼痛和增大前来我院就诊。患者无外伤史。体格检查发现枕部中线有一个搏动性头皮肿块，大小为3.5×3.5×1厘米。可闻及响亮的血管杂音。有压痛。肿块上方皮肤略呈红色。未发现局灶性神经功能缺损。头颅平片显示枕骨中线有一个圆形缺损。磁共振成像（MRI）显示皮下肿块呈低信号强度，幕下肿块有流空信号。三维CT血管造影显示皮下血管肿块有一条大静脉汇入右侧横窦。颈外动脉血管造影显示头皮内有一个血管病变，由双侧枕动脉分支和脑膜动脉供血。畸形血管团穿透颅骨并与一个扩张的静脉曲张相连，该静脉曲张有一条引流静脉分流至右侧横窦。在栓塞右侧脑膜供血动脉后，进行了手术。血管病变穿透颅骨和硬脑膜。幕下肿块位于蛛网膜下腔，由一条小软脑膜动脉供血。在阻断软脑膜动脉和引流静脉后，肿块被完全切除。术后病程顺利。组织学检查显示皮下肿块和幕下血管肿块分别为AVM和静脉曲张。
