Hanigan W C, Brady T, Medlock M, Smith E B
Department of Neurosciences University of Illinois College of Medicine, Peoria.
J Neurosurg. 1990 Dec;73(6):954-7. doi: 10.3171/jns.1990.73.6.0954.
A unique case of spontaneous regression of giant arteriovenous fistulae during infancy is described in this report. A female infant, the product of normal labor and delivery, demonstrated severe ventriculomegaly and an intracranial hemorrhage at birth. Cerebral angiography at 5 days of age revealed several large fistulae fed by the anterior and middle cerebral arteries draining into the deep venous system through a dilated internal cerebral vein and ectatic vein of Galen. Two days following the angiogram, a second intracranial hemorrhage occurred. Active hydrocephalus developed over the next 6 months and was treated with ventriculoperitoneal shunting. When the child was 8 months of age, angiography failed to demonstrate the fistulae. It was postulated that pressure effects from the intracranial hematoma and long-standing intracranial hypertension as well as stenosis in the anomalous venous outflow resulted in vascular stasis, venous thrombosis, and selective arterial occlusion. Hydrocephalus was a result of the compression of the intraventricular foramina by dilated embryonic vessels. This anomaly, predominantly involving the anterior circulation, may be homologous to the vein of Galen aneurysm in the posterior circulation.
本报告描述了1例婴儿期巨大动静脉瘘自然消退的罕见病例。一名经正常分娩出生的女婴，出生时即表现出严重的脑室扩大和颅内出血。出生5天时的脑血管造影显示，有数个由大脑前动脉和大脑中动脉供血的大瘘管，通过扩张的大脑内静脉和大脑大静脉引流至深部静脉系统。血管造影后2天，发生了第二次颅内出血。在接下来的6个月里出现了进行性脑积水，并接受了脑室腹腔分流术治疗。当患儿8个月大时，血管造影未显示瘘管。据推测，颅内血肿的压力作用、长期的颅内高压以及异常静脉流出道的狭窄导致了血管淤滞、静脉血栓形成和选择性动脉闭塞。脑积水是由于扩张的胚胎血管压迫脑室孔所致。这种主要累及前循环的异常情况，可能与后循环中的大脑大静脉瘤同源。
