Bayri Yasar, Sakar Mustafa, Ozen Ali, Ziyal Mustafa Ibrahim
Marmara University, School of Medicine, Department of Neurosurgery, İstanbul, Turkey.
Turk Neurosurg. 2017;27(1):151-154. doi: 10.5137/1019-5149.JTN.12015-14.1.
Arteriovenous malformations (AVMs) commonly present with seizures and hemorrhage. Hydrocephalus associated with an unruptured AVM in an adult patient is exceedingly rare. A 37-year-old male patient presented with total visual loss in his right eye and severe impairment in his left eye. His evaluation showed an unruptured right frontal AVM and bilaterally dilated lateral ventricles. The major draining vein of the AVM was obstructing the third ventricle. An urgent external ventricular drainage was used as the first line intervention and followed with a ventriculoperitoneal shunt two days later. His definitive treatment for AVM was staged stereotactic gamma-knife radiosurgery. Unruptured AVMs in adult patients may rarely cause hydrocephalus. Visual loss caused by such a hydrocephalus has not been reported before. Both communicating and non-communicating type hydrocephalus can be seen with unruptured AVMs, and have different pathophysiological mechanisms. Our patient was treated with ventriculoperitoneal shunting, and visual examination remained unchanged after the operation. Visual loss caused by hydrocephalus associated with an unruptured AVM in an adult patient has not been reported before. It may indicate an association of different pathophysiological mechanisms. The treatment must depend on the neurological condition of the patient.
动静脉畸形（AVM）通常表现为癫痫发作和出血。成年患者中，与未破裂AVM相关的脑积水极为罕见。一名37岁男性患者出现右眼完全失明和左眼严重受损。他的检查显示右侧额叶有一个未破裂的AVM以及双侧侧脑室扩张。AVM的主要引流静脉阻塞了第三脑室。紧急进行了外部脑室引流作为一线干预措施，并在两天后进行了脑室腹腔分流术。他针对AVM的确定性治疗是分阶段立体定向伽玛刀放射外科手术。成年患者中未破裂的AVM很少会导致脑积水。此前尚未报道过由这种脑积水引起的视力丧失。未破裂的AVM可导致交通性和非交通性脑积水，且具有不同的病理生理机制。我们的患者接受了脑室腹腔分流术治疗，术后视力检查结果未改变。此前尚未报道过成年患者中由未破裂AVM相关的脑积水引起的视力丧失。这可能表明存在不同病理生理机制之间的关联。治疗必须取决于患者的神经状况。
