Gamblin Austin, Nguyen Sarah, Fredrickson Vance, Grandhi Ramesh, Couldwell William T
Neurosurgery, University of Utah, Salt Lake City, USA.
Cureus. 2021 Jul 15;13(7):e16410. doi: 10.7759/cureus.16410. eCollection 2021 Jul.
Postoperative digital subtraction angiography (DSA) is the gold standard for establishing a cure of an arteriovenous malformation (AVM) after treatment. The incidence of residual AVM identified on postoperative DSA ranges from 1.8 to 11%. Although this is important for finalizing the treatment of AVMs, postoperative DSA rarely shows new findings that were not previously identified on preoperative imaging. We present a unique case where we identified residual AVM nidus on immediate postoperative DSA that drained into two deep veins that were not evident on preoperative DSA and increased the AVM grade from Spetzler-Martin grade II to III. To our knowledge, this finding has not been previously reported in the literature. We resected the residual AVM nidus identified on postoperative DSA, leading to an angiographic cure. The patient demonstrated a postoperative right-sided supplementary motor area syndrome that resolved over time with therapy. She made a complete functional recovery by her one-month follow-up appointment.
术后数字减影血管造影（DSA）是确定动静脉畸形（AVM）治疗后治愈情况的金标准。术后DSA检查发现残留AVM的发生率在1.8%至11%之间。虽然这对于确定AVM的最终治疗很重要，但术后DSA很少显示出术前影像学检查未发现的新发现。我们报告了一例独特病例，术后即刻DSA发现残留AVM病灶，其引流至两条术前DSA未显示的深部静脉，使AVM分级从斯佩茨勒-马丁Ⅱ级升至Ⅲ级。据我们所知，这一发现此前尚未见文献报道。我们切除了术后DSA发现的残留AVM病灶，实现了血管造影治愈。患者术后出现右侧辅助运动区综合征，经治疗后随时间推移症状缓解。在术后1个月的随访预约时，她实现了完全功能恢复。
