Geibprasert Sasikhan, Pereira Vitor, Krings Timo, Jiarakongmun Pakorn, Lasjaunias Pierre, Pongpech Sirintara
Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Neurosurg. 2009 Mar;110(3):500-7. doi: 10.3171/2008.7.JNS0815.
The goal in this study was to present possible pathological mechanisms, clinical and imaging findings, and to describe the management and outcome in patients with hydrocephalus due to unruptured pial brain arteriovenous malformations (AVMs).
Medical records and imaging findings in 8 consecutive patients with hydrocephalus caused by AVMs and treated between June 2000 and September 2007 were retrospectively reviewed to determine clinical symptoms, AVM location, venous drainage, level/cause of obstruction, and degree of hydrocephalus. Management of hydrocephalus, AVM treatment, complications, and follow-up results were evaluated.
Headaches were the most common clinical symptom (7 of 8 patients). Deep venous drainage was identified in all patients. Mechanical obstruction by the draining vein or the AVM nidus was seen in 6 patients, in whom obstruction occurred at the interventricular foramen (2 patients) or the aqueduct (4 patients). Hydrodynamic disorders following venous outflow obstruction and venous congestion of the posterior fossa led to hydrocephalus in the remaining 2 patients. Ventriculoperitoneal (VP) shunts were placed in 6 of 8 patients with a moderate to severe degree of hydrocephalus. Regression of hydrocephalus was noted in 4 patients, whereas in 2 the imaging findings were stable, 1 of whom had decreased hydrocephalus only after AVM size reduction. In 2 patients with mild hydrocephalus who were not treated with shunt insertion, 1 improved and 1 was clinically stable after AVM treatment.
The most common cause of hydrocephalus in unruptured brain AVMs is mechanical obstruction by the draining vein if it is located in a strategic position. Management should be aimed at treatment of the AVM; however, VP shunts may be necessary in acute and severe cases of hydrocephalus.
本研究的目的是阐述未破裂软脑膜脑动静脉畸形（AVM）所致脑积水患者可能的病理机制、临床及影像学表现，并描述其治疗方法及预后。
回顾性分析2000年6月至2007年9月期间连续收治的8例因AVM导致脑积水患者的病历及影像学检查结果，以确定临床症状、AVM位置、静脉引流情况、梗阻平面/原因及脑积水程度。评估脑积水的治疗、AVM治疗、并发症及随访结果。
头痛是最常见的临床症状（8例患者中的7例）。所有患者均发现有深部静脉引流。6例患者可见引流静脉或AVM病灶引起的机械性梗阻，其中梗阻发生在室间孔（2例患者）或导水管（4例患者）。其余2例患者因静脉流出道梗阻及后颅窝静脉淤血导致的流体动力学紊乱而引起脑积水。8例中度至重度脑积水患者中有6例行脑室腹腔（VP）分流术。4例患者脑积水有所减轻，2例患者影像学表现稳定，其中1例仅在AVM体积缩小后脑积水有所减轻。2例轻度脑积水患者未行分流术，1例在AVM治疗后病情改善，1例临床症状稳定。
未破裂脑AVM所致脑积水最常见的原因是引流静脉位于关键位置时引起的机械性梗阻。治疗应针对AVM；然而，在急性和严重脑积水病例中可能需要行VP分流术。
