Utsuki S, Kurata A, Miyasaka Y, Takano M, Ootaka H, Fujii K
Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara City, Kanagawa, Japan.
Acta Neurochir (Wien). 2002 Jan;144(1):97-101. doi: 10.1007/s701-002-8279-0.
A rare case of a left temporal arteriovenous malformation (AVM) with bleeding 10 days after removal of another hemorrhagic AVM in the frontal lobe is reported.
A 47-year-old man had an attack of headache and vomiting and was admitted to our hospital. On admission, a CT scan showed subcortical hemorrhage in the left frontal lobe. Left carotid angiography revealed four AVMs and a vertebro-basilar angiogram demonstrated a vascular malformation.
First, a hemorrhagic AVM was removed with a hematoma. Following the operation, left carotid angiograms continued to show, AVMs, particularly a temporal AVM with increased blood flow, and after 10 days this hemorrhaged. This was surgically resected and the remaining small AVMs were treated by stereotactic radiosurgery.
The patient had a high risk of hemorrhage. Adding hemodynamic stress to this situation, hemorrhage would have been expected to occur at an early time after the initial intervention for hemorrhagic AVM. Considering the risk of hemorrhage, other AVMs should undergo surgery as soon as possible after resection of hemorrhagic AVM.
报告了1例罕见病例，患者在额叶另1例出血性动静脉畸形（AVM）切除术后10天，左侧颞叶AVM发生出血。
一名47岁男性因头痛和呕吐发作入院。入院时，CT扫描显示左侧额叶皮质下出血。左侧颈动脉血管造影显示4个AVM，椎动脉血管造影显示一处血管畸形。
首先，切除了一个伴有血肿的出血性AVM。术后，左侧颈动脉血管造影持续显示存在AVM，尤其是一处血流增加的颞叶AVM，10天后该AVM出血。对其进行了手术切除，其余小AVM通过立体定向放射外科治疗。
该患者出血风险高。在这种情况下增加血流动力学压力，预计出血会在出血性AVM初次干预后的早期发生。考虑到出血风险，出血性AVM切除后，其他AVM应尽快接受手术。
