Garel C, Azarian M, Lasjaunias P, Luton D
Department of Paediatric Imaging, Paris, France.
Ultrasound Obstet Gynecol. 2005 Sep;26(3):293-6. doi: 10.1002/uog.1957.
We report three cases of the antenatal appearance of a pial arteriovenous fistula (AVF). In Case 1, the diagnosis of pial AVF was made by ultrasound examination at 32 + 3 weeks of gestation and confirmed by magnetic resonance imaging (MRI) at 34 + 3 weeks of gestation. After birth, the neonate had cardiac insufficiency and an embolization was performed 8 days postpartum which was followed by extended cerebral ischemia and death. In Cases 2 and 3 pial fistulae were diagnosed at birth. In Case 2, the patient was referred following the diagnosis of an aneurysmal malformation of the vein of Galen at 38 weeks of gestation. Owing to immediate delivery following her transfer, no ultrasound examination was performed and the diagnosis of pial AVF was established on the first postnatal day. An embolization was performed and the child is doing well. Case 3 presented with cardiomegaly at 30 weeks of gestation and cerebral ischemic lesions after birth. These cases highlight the difficulties encountered in the prenatal diagnosis of pial AVFs. The diagnosis should be considered in cases of unexplained cardiomegaly and it is also important to make sure that AVFs draining into the vein of Galen are not misdiagnosed as aneurysmal malformations of this vein. The complications of pial AVFs are cardiac failure and cerebral ischemia. Embolization is the treatment of choice; however it is a risky procedure in neonates.
我们报告了三例软膜动静脉瘘（AVF）的产前表现。病例1中，在妊娠32 + 3周时通过超声检查诊断为软膜AVF，并在妊娠34 + 3周时通过磁共振成像（MRI）得以证实。出生后，新生儿出现心脏功能不全，产后8天进行了栓塞治疗，随后发生广泛性脑缺血并死亡。病例2和病例3在出生时被诊断为软膜瘘。病例2中，患者在妊娠38周时被诊断为大脑大静脉瘤样畸形后前来就诊。由于转诊后立即分娩，未进行超声检查，在出生后第一天确诊为软膜AVF。进行了栓塞治疗，患儿情况良好。病例3在妊娠30周时出现心脏扩大，出生后有脑缺血性病变。这些病例凸显了软膜AVF产前诊断中遇到的困难。对于不明原因的心脏扩大病例应考虑该诊断，同时确保引流至大脑大静脉的AVF不被误诊为该静脉的瘤样畸形也很重要。软膜AVF的并发症是心力衰竭和脑缺血。栓塞是首选治疗方法；然而，这对新生儿来说是一项有风险的操作。
