Department of Neurosurgery, Weill-Cornell College of Medicine/New York Presbyterian Hospital, 525 East 68th Street, Box, New York, NY, 99, USA.
Columbia University, New York, NY, USA.
BMC Neurol. 2020 Apr 13;20(1):131. doi: 10.1186/s12883-020-01714-3.
Cavernous malformations are rare cerebral pseudo-vascular lesions with annualized bleeding rates of 0.5-3% in most studies. Of the various explored risk factors for bleeding to date, only prior hemorrhage has shown significant correlation.
In this case, we describe a 65-year old man with a peri-ventricular atrial cavernous malformation that hemorrhaged after CSF diversion via ventriculoperitoneal shunting. Serial imaging showed that bleeding continued until the shunt was revised with a programmable valve set at maximum resistance with the addition of a gravitational unit, thereby lowering the trans-mural pressure differential across the cavernous malformation.
Given that other vascular lesions are subject to hemorrhage from alterations in trans-mural pressure dynamics, we hypothesize that cavernous malformations are similarly affected by trans-mural pressure gradients as they are composed of primitive vascular elements. This hypothesis is corroborated by the temporal correlation of interventions, imaging, and exam findings in the present case, and suggests a potentially important risk factor for hemorrhage in CM patients that affects prognostication and management.
海绵状血管畸形是一种罕见的脑部假性血管病变，大多数研究报告的年出血率为 0.5-3%。迄今为止，在各种探索的出血风险因素中，只有既往出血与之有显著相关性。
本例中，我们描述了一位 65 岁男性，其脑室周围的心房海绵状血管畸形在通过脑室-腹腔分流术进行脑脊液分流后发生出血。连续影像学检查显示，出血持续到分流管更换，使用可编程阀门设置为最大阻力，并增加重力装置，从而降低穿过海绵状血管畸形的跨壁压力差。
鉴于其他血管病变会因跨壁压力动力学改变而发生出血，我们假设海绵状血管畸形也会受到跨壁压力梯度的影响，因为它们由原始血管成分组成。这一假设在本病例中得到了干预、影像学和检查结果的时间相关性的证实，并提示了一种影响海绵状血管畸形患者预后和管理的潜在重要出血风险因素。
