Osada Yoshinari, Endo Hidenori, Sato Kenichi, Matsumoto Yasushi, Endo Toshiki, Fujimura Miki, Tominaga Teiji
1 Department of Neurosurgery and Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan.
2 Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Interv Neuroradiol. 2017 Dec;23(6):656-660. doi: 10.1177/1591019917728255. Epub 2017 Sep 11.
We report a case of a 39-year-old man presenting with a high-grade left parieto-occipital arteriovenous malformation (AVM) complicated by superior sagittal sinus (SSS) stenosis, seven years after the first presentation. Magnetic resonance imaging revealed a newly developed perilesional edema. Venous sinus stenosis acutely progressed to occlusion and induced multiple intracerebral hemorrhages. An emergent balloon venoplasty of the SSS successfully recanalized the thrombosed sinus. Further, multistage transarterial nidus embolization was performed followed by surgical resection, resulting in a complete eradication of the large AVM. The emergence of perilesional edema is a key radiological feature for the early recognition of a newly developed venous drainage route disturbance, which would result in hemorrhagic events. Venous sinus thrombosis is a rare cause of drainage route disturbance in cerebral AVMs. For such cases, the recanalization of venous drainage concomitant with flow reduction by performing transarterial embolization is effective in preventing further hemorrhage, which enables a safe performance of subsequent radical surgery.
我们报告一例39岁男性患者，首次就诊7年后出现高级别左侧顶枕部动静脉畸形（AVM）并伴有上矢状窦（SSS）狭窄。磁共振成像显示新出现的病灶周围水肿。静脉窦狭窄急性进展至闭塞并引发多处脑内出血。紧急对SSS进行球囊血管成形术成功使血栓形成的窦再通。此外，进行了多阶段经动脉病灶栓塞，随后进行手术切除，从而彻底根除了大型AVM。病灶周围水肿的出现是早期识别新出现的静脉引流途径紊乱的关键影像学特征，这会导致出血事件。静脉窦血栓形成是脑AVM中引流途径紊乱的罕见原因。对于此类病例，通过经动脉栓塞减少血流量的同时使静脉引流再通，对于预防进一步出血有效，这使得后续根治性手术能够安全进行。
