Ziyal I M, Ece K, Bilginer B, Tezel G G, Ozcan O E
Department of Neurosurgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
Acta Neurochir (Wien). 2004 Jan;146(1):83-6; discussion 86. doi: 10.1007/s00701-003-0161-8. Epub 2003 Dec 5.
A 58-year-old male was admitted with headache to our neurosurgery clinic. His neurological examination revealed slight left hemiparesis. The radiological evaluation with contrast administred magnetic resonance imaging (MRI) scan demonstrated a right temporo-parietal ring enhancing mass lesion surrounded by edema which was resembling a typical glioma (Fig. 1). The patient was operated on via a temporo-parietal craniotomy and an arteriovenous malformation surrounded by abnormal glial tissue was observed during the exposure. A nidus supplied by several branches arising from the middle cerebral artery (MCA) was obvious. The venous drainage of the malformation was to the superficial venous system. The observed arterial feeders and the draining vein were coagulated and the nidus was macroscopically totally excised. The frozen examination from surrounding glial tissue revealed a high grade glioma. The tumor was also macroscopically totally excised. Postoperatively, the cerebral angiogram demonstrated a right temporal arteriovenous malformation with a centrally excised nidus. The remaining major feeders involved the angular gyrus and the posterior temporal arteries. The venous drainage was to the straight and sigmoid sinuses (Fig. 2). The final histopathological examination of the specimen revealed an arteriovenous malformation surrounded by a high grade glioma (Fig. 3). The patient refused a second operation for total removal of the AVM. Postoperatively, he is doing well with improvement of his left hemiparesis.
一名58岁男性因头痛入住我院神经外科门诊。神经系统检查发现轻度左侧偏瘫。增强磁共振成像（MRI）扫描的影像学评估显示右侧颞顶叶有一个环形强化肿块病变，周围有水肿，类似典型的胶质瘤（图1）。患者通过颞顶开颅手术进行治疗，术中暴露时观察到一个被异常胶质组织包围的动静脉畸形。由大脑中动脉（MCA）发出的几个分支供血的病灶明显。畸形的静脉引流至浅静脉系统。观察到的供血动脉和引流静脉进行了凝固处理，病灶在肉眼下完全切除。周围胶质组织的冰冻检查显示为高级别胶质瘤。肿瘤在肉眼下也完全切除。术后，脑血管造影显示右侧颞叶动静脉畸形，病灶已在中心切除。其余主要供血动脉累及角回和颞后动脉。静脉引流至直窦和乙状窦（图2）。标本的最终组织病理学检查显示一个动静脉畸形被高级别胶质瘤包围（图3）。患者拒绝再次手术以完全切除动静脉畸形。术后，他恢复良好，左侧偏瘫有所改善。
