Echeverría Kléber González, da Costa Marcos Devanir Silva, Costa Bruno Lourenço, Ortiz Robert Zanabria, Paganelli Samantha Lorena, Granados Oliver Soto, Doria-Netto Hugo Leonardo, Centeno Ricardo Silva, Chaddad-Neto Feres
Department of Neurosurgery, Universidade Federal de Sao Paulo, São Paulo-SP, Brazil.
Division of Neurosurgery, Hospital Beneficencia Portuguesa de Sao Paulo, Sao Paulos-SP, Brazil.
Oper Neurosurg. 2020 Jan 1;18(1):E17. doi: 10.1093/ons/opz091.
We present a 14-yr-old male with a history of traumatic brain injury in March 2016, secondary to clonic tonic generalized seizures. CT scan showed hemorrhage at mesial temporal region in the body of right hippocampus, intraventricular hemorrhage at the level of lateral ventricles (right and left side) and fourth ventricle. After this the patient presented with pulsating right temporal headache of high intensity (VAS 10/10) that improved with common analgesics, dizziness, and clonic tonic generalized seizures despite taking Phenobarbital 100 mg/24 h. Neuropsychological assessment reveal major deficits regarding executive functions: working memory, verbal fluency, and planning abilities. Brain MRI and angiography showed AVM at the right level of hippocampus body. An intranidal aneurysm was also observed. Venous drainage was through the basal vein of Rosenthal. We planned for surgery and resection of the hippocampal AVM through the trans-T2 approach. Postoperatively, the patient was without medical complications. We present a 3-dimensional video of the microsurgical treatment for right hippocampal AVM performed through a trans-T2 approach. The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any type of medical publications in conferences and/or scientific articles.
我们报告一名14岁男性,有2016年3月创伤性脑损伤病史,继发阵挛性强直全身性癫痫发作。CT扫描显示右侧海马体体部内侧颞叶区域出血、侧脑室(右侧和左侧)及第四脑室水平的脑室内出血。此后,患者出现高强度搏动性右侧颞部头痛(视觉模拟评分10/10),服用普通镇痛药后有所改善,伴有头晕,尽管每天服用100mg苯巴比妥仍有阵挛性强直全身性癫痫发作。神经心理学评估显示执行功能存在重大缺陷:工作记忆、语言流畅性和计划能力。脑部MRI和血管造影显示右侧海马体体部水平有动静脉畸形(AVM)。还观察到一个瘤内动脉瘤。静脉引流通过罗森塔尔基底静脉。我们计划通过经T2入路对海马体AVM进行手术切除。术后,患者无医疗并发症。我们展示了一段通过经T2入路对右侧海马体AVM进行显微手术治疗的三维视频。患者签署了机构同意书,允许在会议和/或科学文章中使用其图像和视频用于任何类型的医学出版物。