Zhang Michael, Connolly Ian D, Teo Mario K, Yang George, Dodd Robert, Marks Michael, Zuccarello Mario, Steinberg Gary K
Department of Neurosurgery and Stanford Stroke Center, Stanford University Medical Center, Stanford, California, USA.
Department of Neurosurgery and Stanford Stroke Center, Stanford University Medical Center, Stanford, California, USA; Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, North Bristol University Hospital, Bristol, UK.
World Neurosurg. 2017 Oct;106:563-569. doi: 10.1016/j.wneu.2017.07.042. Epub 2017 Jul 19.
Classification of cerebrovascular malformations has revealed intermediary lesions that warrant further review owing to their unusual presentation and management. We present 2 cases of arteriovenous malformation (AVM) associated with a developmental venous anomaly (DVA), and discuss the efficacy of previously published management strategies.
Two cases of AVMs associated with DVA were identified, and a literature search for published cases between 1980 and 2016 was conducted. Patient demographic data and clinical features were documented.
In case 1, a 29-year-old female presenting with parenchymal hemorrhage and left homonymous hemianopia was found to have a right parieto-occipital AVM fed from the anterior cerebral, middle cerebral, and posterior cerebral arteries, with major venous drainage to the superior sagittal sinus. In case 2, imaging in a 34-year-old female evaluated for night tremors and incontinence revealed a left parietal AVM with venous drainage to the superior sagittal sinus. Including our 2 cases, 22 cases of coexisting AVMs and DVAs have been reported in the literature. At presentation, 68% had radiographic evidence of hemorrhage. Stereotactic radiosurgery was performed in 7 cases, embolization in 6 cases, surgical resection in 4 cases, and multimodal therapy in 5 cases. Radiography at follow-up demonstrated successful AVM obliteration in 67% of cases (12 of 18).
Patients with coexisting AVMs and DVAs tend to have a hemorrhagic presentation. Contrary to traditional AVM management, in these cases it is important to preserve the draining vein via the DVA to ensure a safe, sustained circulatory outflow of the associated brain parenchyma while achieving safe AVM obliteration.
脑血管畸形的分类已揭示出一些中间病变，因其不寻常的表现和处理方式而值得进一步研究。我们报告2例与发育性静脉异常（DVA）相关的动静脉畸形（AVM）病例，并讨论先前发表的处理策略的疗效。
确定2例与DVA相关的AVM病例，并对1980年至2016年间发表的病例进行文献检索。记录患者的人口统计学数据和临床特征。
病例1为一名29岁女性，表现为实质内出血和左侧同向性偏盲，发现其右侧顶枕部AVM由大脑前动脉、大脑中动脉和大脑后动脉供血，主要静脉引流至矢状窦。病例2为一名34岁女性，因夜间震颤和尿失禁接受评估，影像学检查发现左侧顶叶AVM，静脉引流至矢状窦。包括我们的2例病例在内，文献中已报道22例共存的AVM和DVA病例。就诊时，68%有出血的影像学证据。7例行立体定向放射外科治疗，6例行栓塞治疗，4例行手术切除，5例行多模式治疗。随访时的影像学检查显示67%的病例（18例中的12例）AVM成功闭塞。
共存AVM和DVA的患者往往有出血表现。与传统的AVM处理方法相反对于这些病例，重要的是通过DVA保留引流静脉，以确保相关脑实质安全、持续的循环流出，同时实现AVM的安全闭塞。
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