Chua Melissa M J, Gupta Saksham, Essayed Walid Ibn, Donnelly Dustin J, Ziayee Habibullah, Vicenty-Padilla Juan, Das Alvin S, Lai Rosalind P M, Izzy Saef, Aziz-Sultan Mohammad Ali
Departments of Neurosurgery and.
Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Neurosurg Case Lessons. 2021 Jan 11;1(2):CASE2073. doi: 10.3171/CASE2073.
Pure arterial malformations (PAMs) are rare vascular anomalies that are commonly mistaken for other vascular malformations. Because of their purported benign natural history, PAMs are often conservatively managed. The authors report the case of a ruptured PAM leading to subarachnoid hemorrhage (SAH) with intraventricular extension that was treated endovascularly.
A 38-year-old man presented with a 1-day history of headaches and nausea. A computed tomography scan demonstrated diffuse SAH with intraventricular extension, and angiography revealed a right posterior inferior cerebellar artery-associated PAM. The PAM was treated with endovascular Onyx embolization.
To the authors' knowledge, only 2 other cases of SAH associated with PAM have been reported. In those 2 cases, surgical clipping was pursued for definitive treatment. Here, the authors report the first case of a ruptured PAM treated using an endovascular approach, showing its feasibility as a treatment option particularly in patients in whom open surgery is too high a risk.
纯动脉畸形（PAMs）是罕见的血管异常，常被误诊为其他血管畸形。由于其所谓的良性自然病程，PAMs通常采用保守治疗。作者报告了一例破裂的PAM导致蛛网膜下腔出血（SAH）并伴有脑室内扩展，采用血管内治疗的病例。
一名38岁男性，有1天的头痛和恶心病史。计算机断层扫描显示弥漫性SAH并伴有脑室内扩展，血管造影显示与右小脑后下动脉相关的PAM。该PAM采用血管内Onyx栓塞治疗。
据作者所知，仅有另外2例与PAM相关的SAH病例报道。在这2例中，采用手术夹闭进行确定性治疗。在此，作者报告了首例采用血管内方法治疗破裂PAM的病例，显示了其作为一种治疗选择的可行性，特别是对于那些开放手术风险过高的患者。
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