de Carvalho Joana Chaves Gonçalves Rodrigues, Machin Francisco Javier Tercero, Manzanera Luis San Roman, Andaluz Jordi Blasco, Nogués Sílvia Herrero, Soriano Núria Peix, Baurier Victor Obach, Carrero Cardenal Enrique Jesus
Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Departamento de Anestesiologia, Matosinhos, Portugal.
Universidad de Barcelona, Hospital Clínic, Departamento de Anestesiología, Barcelona, Spain.
Braz J Anesthesiol. 2017 Mar-Apr;67(2):199-204. doi: 10.1016/j.bjane.2014.07.015. Epub 2014 Oct 31.
Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases.
A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae.
Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.
硬脑膜动静脉瘘是硬脑膜动脉和静脉通道之间的异常分流，其病灶位于硬脑膜叶之间。在必须进行侵入性治疗的情况下，血管内技术已成为主要的治疗方法，这归因于其已报道的安全性和有效性。我们描述了一例经动脉栓塞治疗硬脑膜动静脉瘘并并发脑室内出血的独特罕见病例。我们旨在强调这些患者围手术期管理的一些核心方面，以帮助改进未来类似病例的治疗方法。
一名59岁女性，先前诊断为Cognard IV型硬脑膜动静脉瘘，在全静脉麻醉下于手术室之外接受经动脉栓塞治疗。手术过程顺利，无并发症，术中血管造影显示瘘管完全闭塞。术后早期，患者出现颅内压升高的临床症状，原因是后来诊断出的脑室内出血，这导致放置脑室引流管、入住重症监护病房、脑血管痉挛以及住院时间延长。在整个围手术期，脑血氧饱和度没有变化。患者出院时无神经后遗症。
脑室内出血可能是硬脑膜动静脉瘘血管内治疗后的严重并发症。密切的术后监测可实现早期诊断和治疗，从而增加改善预后的几率。
