Yamada Shuichi, Nakase Hiroyuki, Nakagawa Ichiro, Nishimura Fumihiko, Motoyama Yasushi, Park Young-Su
Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
Neurol Med Chir (Tokyo). 2013;53(8):555-60. doi: 10.2176/nmc.53.555.
Cavernous malformation is a relatively rare disease, but is important in the etiology of cerebral hemorrhage in pregnant and puerperal women. The risk of bleeding is particularly high in patients with a previous history of bleeding, patients with a family history of cavernous malformations, and patients with the causative cerebral cavernous malformation gene. Cavernous malformations are more likely to bleed or to increase in size during pregnancy, under the influence of female hormones and vascular growth factors such as vascular endothelial growth factor. We report our strategy for the treatment of cavernous malformations in pregnant women, with reference to the relevant literature. Asymptomatic patients and those with mild symptoms are usually followed up conservatively by magnetic resonance imaging, without active treatment, but surgical treatment is indicated in patients with severe or progressive symptoms; surgery should also be considered in patients with mild symptoms having risk factors for bleeding. If surgical treatment is selected, the operation plan needs to be devised in collaboration with the specialties of anesthesiology and obstetrics and gynecology, rather than by the brain surgeon alone, in view of the possibility of occurrence of complications specific to pregnant women, such as complications related to weight gain and difficulty in securing the airway, which develop during the perioperative period.
海绵状血管畸形是一种相对罕见的疾病，但在孕产妇脑出血的病因中具有重要意义。既往有出血史的患者、有海绵状血管畸形家族史的患者以及携带致病性脑海绵状血管畸形基因的患者出血风险尤其高。在雌激素和血管内皮生长因子等血管生长因子的影响下，海绵状血管畸形在孕期更易出血或增大。我们参考相关文献报告了我们对孕妇海绵状血管畸形的治疗策略。无症状患者和症状较轻的患者通常通过磁共振成像进行保守随访，不进行积极治疗，但症状严重或进行性加重的患者则需进行手术治疗；有出血危险因素的轻症患者也应考虑手术治疗。如果选择手术治疗，鉴于围手术期可能出现孕妇特有的并发症，如与体重增加和气道管理困难相关的并发症，手术方案需要与麻醉科及妇产科专家共同制定，而不是仅由脑外科医生决定。
