Agazzi S, Regli L, Uske A, Maeder P, de Tribolet N
Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
J Neurosurg. 2001 Mar;94(3):533-7. doi: 10.3171/jns.2001.94.3.0533.
Developmental venous anomalies (DVAs) are common congenital variations of normal venous drainage that are known for their benign natural history. Isolated cases of symptomatic DVAs with associated arteriovenous (AV) shunts have recently been reported. The present case, in which thrombosis occurred in a DVA involving an AV shunt, raises intriguing questions regarding the clinical characteristics of these lesions and can be used to argue in favor of considering such lesions to be arteriovenous malformations (AVMs). A 39-year-old man presented with acute thrombosis in a complex system of anomalous hemispheric venous drainage, which included two distinct DVAs, one of which involved an AV shunt. The hemodynamic turbulences induced by a communication between shunted and normal venous outflows were the possible predisposing factor of the thrombosis. Follow-up angiographic and magnetic resonance images revealed complete recanalization of the thrombosed vessel and provided a thorough visualization of the particular angioarchitecture of the DVA. Acute thrombosis within a DVA with an AV shunt has not been reported previously and, thus, this case can be added to other reports of complications that arise in this particular type of DVA. The authors hypothesize that the presence of an AV shunt in a DVA is a risk factor for aggressive clinical behavior of the anomaly, rendering those lesions prone to complications similar to AVMs. Although no treatment can be offered, the presence of an AV shunt in a DVA warrants close follow-up observation because such lesions may represent a particular subtype of AVM and, therefore, may exhibit an aggressive clinical behavior.
发育性静脉异常（DVAs）是正常静脉引流常见的先天性变异，以其良性自然病程而闻名。最近有孤立的伴有动静脉（AV）分流的有症状DVAs病例报道。本病例中，一个伴有AV分流的DVA发生了血栓形成，引发了关于这些病变临床特征的有趣问题，可用于支持将此类病变视为动静脉畸形（AVMs）的观点。一名39岁男性出现急性血栓形成，位于一个复杂的半球异常静脉引流系统中，该系统包括两个不同的DVAs，其中一个涉及AV分流。分流的静脉流出与正常静脉流出之间的交通所引起的血流动力学紊乱可能是血栓形成的诱发因素。随访血管造影和磁共振图像显示血栓形成的血管完全再通，并全面展示了DVA独特的血管结构。此前尚未报道过伴有AV分流的DVA内发生急性血栓形成的情况，因此，该病例可补充到关于这种特殊类型DVA出现并发症的其他报道中。作者推测，DVA中AV分流的存在是该异常侵袭性临床行为的一个危险因素，使这些病变易于出现与AVM相似的并发症。尽管无法提供治疗，但DVA中AV分流的存在值得密切随访观察，因为此类病变可能代表AVM的一种特殊亚型，因此可能表现出侵袭性临床行为。
