Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Neurointerv Surg. 2011 Sep;3(3):293-6. doi: 10.1136/jnis.2010.002972. Epub 2011 Apr 6.
Cobb syndrome is a rare condition that includes a cutaneous nevus with an associated spinal vascular lesion at the same dermatome. We present a challenging case of a progressively symptomatic massive lumbosacral arteriovenous malformation (AVM) in a patient with Cobb's syndrome requiring a multimodality approach including staged preoperative transarterial and transvenous endovascular embolization followed by surgical excision and wound reconstruction.
The patient presented with a massive lumbosacral AVM with symptoms of congestive heart failure. Angiography demonstrated arterial feeders predominantly from internal iliac, median sacral and lumbar segmental arteries.
The patient underwent staged transarterial and transvenous endovascular embolization resulting in 90% reduction in the AVM size, followed by surgical resection of the lesion. The patient made an excellent recovery with improvement in his symptoms of congestive heart failure.
The treatment algorithm for massive AVMs must be individualized. A combination of staged embolization and subsequent surgery may be required to obtain a good result. Through this carefully planned multidisciplinary approach a previously incurable lesion in this patient with Cobb syndrome was able to be treated successfully.
Cobb 综合征是一种罕见的疾病，包括在同一皮节处具有皮肤痣和相关的脊髓血管病变。我们提出了一个具有挑战性的病例，即 Cobb 综合征患者的进行性症状性巨大腰骶部动静脉畸形（AVM）需要采用多模态方法治疗，包括分期术前经动脉和经静脉血管内栓塞，随后进行手术切除和伤口重建。
患者表现为巨大的腰骶部 AVM，并伴有充血性心力衰竭的症状。血管造影显示主要的动脉供血来自髂内动脉、正中骶动脉和腰椎节段动脉。
患者接受了分期经动脉和经静脉血管内栓塞治疗，使 AVM 大小减少了 90%，随后进行了病变的手术切除。患者恢复良好，充血性心力衰竭的症状得到改善。
巨大 AVM 的治疗方案必须个体化。可能需要分期栓塞和随后的手术来获得良好的效果。通过这种精心规划的多学科方法，成功地治疗了 Cobb 综合征患者以前无法治愈的病变。
