Sy E C N, Melot A, Troude L, Al-Falasi M, Brunel H, Roche P-H
Service de neurochirurgie, CHU de Fann Dakar-Sénégal, avenue Cheikh-Anta DIOP, 5035 Dakar, Sénégal.
Service de neurochirurgie, hôpital Nord, 10700 Marseille, France.
Neurochirurgie. 2018 Sep;64(4):316-320. doi: 10.1016/j.neuchi.2018.04.005. Epub 2018 Jun 13.
Endovascular embolization is an essential therapeutic approach in the multidisciplinary management of cerebral arteriovenous malformations (AVM). However, it rarely occludes the AVM in its entirety. It is often combined with surgery or stereotactic radiosurgery. The aim of embolization is to reduce the size of the nidus and the intra-nidal flow in order to facilitate the microsurgical or the radiosurgical procedure. We report the case of a 61-year-old patient with a right frontal hemorrhagic AVM treated with complete embolization in a single session. Initially, a surgical procedure for excision of the AVM was scheduled 24hours post-embolization. This surgery was canceled due to a good angiographic result of the embolization. Eight days post-embolization, there was a massive re-bleed of the AVM which justified emergency surgical management. This case illustrates a delayed post-embolization hemorrhagic complication of an occluded AVM and prompts a review of the therapeutic strategy of the cerebral AVM to select the most effective and least morbid procedure or combination of procedures.
血管内栓塞是脑动静脉畸形（AVM）多学科治疗中的重要治疗方法。然而，它很少能完全闭塞AVM。它常与手术或立体定向放射外科联合使用。栓塞的目的是减小畸形团的大小和畸形团内的血流，以便于进行显微外科手术或放射外科手术。我们报告一例61岁右额叶出血性AVM患者，单次治疗即实现完全栓塞。最初，计划在栓塞后24小时进行AVM切除手术。由于栓塞的血管造影结果良好，该手术被取消。栓塞后8天，AVM发生大量再出血，这使得紧急手术治疗成为必要。该病例说明了已闭塞AVM的栓塞后延迟出血并发症，并促使我们重新审视脑AVM的治疗策略，以选择最有效且创伤最小的手术方法或联合手术方法。
