Kimura Yoshinobu, Kamada Yasuhiro, Kimura Akira, Sato Kaori, Namiki Akiyoshi
Department of Anesthesiology, Nikko Memorial Hospital, Muroran 051-8501.
Masui. 2006 Oct;55(10):1231-3.
We report a case of cerebral hemorrhage following ovariectomy in a 39-year-old woman undergoing a gamma knife treatment for intracranial arteriovenous malformation (AVM). She underwent bilateral ovariectomy with combined spinal-epidural anesthesia. Tracheal intubation was not performed so that severe changes in blood pressure, partial carbon dioxide pressure, and partial pressure of oxygen could be avoided. There were no complications during surgical anesthesia, but the AVM ruptured soon after her being discharged. AVM is errors in the development of the vasculature that, together with the effects of blood flow, may lead to a focal arteriovenous shunt. In some cases, aneurysms may coexist with AVM. It is said that radiosurgery significantly decreases the risk of hemorrhage in patients with AVM, even before there is angiographic evidence of obliteration. But it should be kept in mind that anesthetic management must be performed carefully.
我们报告了一例39岁女性的病例,该女性因颅内动静脉畸形(AVM)接受伽玛刀治疗,在卵巢切除术后发生脑出血。她在腰麻联合硬膜外麻醉下接受了双侧卵巢切除术。未进行气管插管,以便避免血压、二氧化碳分压和氧分压的剧烈变化。手术麻醉期间无并发症,但出院后不久AVM破裂。AVM是血管系统发育中的错误,与血流影响一起,可能导致局灶性动静脉分流。在某些情况下,动脉瘤可能与AVM共存。据说放射外科手术可显著降低AVM患者出血的风险,甚至在血管造影显示闭塞之前。但应牢记,必须谨慎进行麻醉管理。