Haryu Shinya, Endo Hidenori, Endo Toshiki, Sato Kenichi, Fujimura Miki, Tominaga Teiji
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
World Neurosurg. 2018 Nov;119:274-277. doi: 10.1016/j.wneu.2018.08.072. Epub 2018 Aug 23.
Varix of the drainage route can spontaneously develop thrombosis and disappear after the treatment of the associated cerebral arteriovenous malformation (AVM). We report a rare case in which a thrombosed cerebral venous varix of the drainage route exhibited growth despite complete resection of the associated cerebral AVM.
A 46-year-old man was diagnosed with an AVM in the left temporal lobe. The AVM was accompanied by a large venous varix in the superficial venous drainage route. Transarterial embolization was performed followed by resection of the nidus. The venous varix in the drainage route was not resected, as it was buried in the temporal lobe of the dominant hemisphere. The venous varix was ligated using a titanium clip and nylon thread. Postoperative angiography confirmed the disappearance of the AVM, and magnetic resonance imaging showed thrombosis of the venous varix. However, follow-up magnetic resonance imaging performed 5 months after surgery showed the enlargement of the thrombosed venous varix and emergence of perilesional cerebral edema. The venous varix was excised by reoperation to prevent further growth. Histopathologic evaluation showed infiltration of macrophages and multinucleated giant cells and proliferation of capillaries vessels within the walls of the varix, particularly around the embolic and ligation materials.
To the best of our knowledge, this is the first report of the growth of a thrombosed cerebral venous varix after the resection of a cerebral AVM. The possible cause of this rare phenomenon is excessive inflammation with neovascularization within the wall of the venous varix during thrombogenesis, enhanced by reaction against embolic and ligation materials.
引流途径的静脉瘤可自发形成血栓，并在相关脑动静脉畸形（AVM）治疗后消失。我们报告一例罕见病例，尽管相关脑AVM已完全切除，但引流途径的血栓性脑静脉瘤仍出现生长。
一名46岁男性被诊断为左侧颞叶AVM。该AVM伴有浅静脉引流途径中的一个大静脉瘤。先进行了经动脉栓塞，随后切除了畸形灶。引流途径中的静脉瘤未予切除，因为它深埋于优势半球的颞叶内。使用钛夹和尼龙线对静脉瘤进行了结扎。术后血管造影证实AVM消失，磁共振成像显示静脉瘤形成血栓。然而，术后5个月进行的随访磁共振成像显示，血栓形成的静脉瘤增大，并出现了瘤周脑水肿。为防止其进一步生长，通过再次手术切除了静脉瘤。组织病理学评估显示，静脉瘤壁内有巨噬细胞和多核巨细胞浸润以及毛细血管增生，尤其是在栓塞材料和结扎材料周围。
据我们所知，这是首例关于脑AVM切除后血栓性脑静脉瘤生长的报告。这种罕见现象的可能原因是血栓形成过程中静脉瘤壁内过度炎症伴新生血管形成，并因对栓塞材料和结扎材料的反应而加重。
