Kugai Miyahito, Suyama Takehiro, Kitano Masahiko, Tominaga Yoshiko, Tominaga Shinsuke
Department of Neurosurgery, Tominaga Hospital, Osaka, Osaka, Japan.
Department of Neurosurgery, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan.
J Neuroendovasc Ther. 2020;14(9):381-389. doi: 10.5797/jnet.cr.2020-0004. Epub 2020 Jun 5.
In cases of cerebral arteriovenous malformation (AVM) in which perforators are involved as feeder, hemostasis is difficult during surgical removal and postoperative hemorrhage may develop. If possible, presurgical embolization should be performed. However, when the anterior choroidal artery (AChA) is the feeder, the risk of embolization is particularly high, and there are few reports describing this situation. Authors report the treatment results of five cases of AVM in which a single operator performed presurgical embolization through the AChA and describe the technique with a review of the literature.
Of the five total cases (three men and two women; average age was 43.4 years [28-68 years]), one case presented with hemorrhage, two with epilepsy, the other ones with headache and trigeminal neuralgia, respectively. The lesions were located in the frontal lobe in one case and in the temporal lobe in four cases. On the Spetzler-Martin (SM) grading scale, four cases were grade III and one was grade IV. The eloquent area was involved within the nidus in four cases. Multimodal treatment was planned because all cases were high-grade AVM. Authors thought that performing presurgical embolization through the AChA would reduce the overall risk of treatment and performed the presurgical embolization. The embolization was possible in all cases, and the AVM was not angiographycally visible through the AChA in three cases. The blood flow through the AChA was reduced in two cases. All cases were awake immediately after embolization and no case had neurological symptom after embolization. CT or MRI after embolization revealed asymptomatic infarction in two cases. The AVM was removed safely without difficulty including hemostasis.
In this series, there were no morbidity and embolization was performed relatively safely. Embolization through the AChA was suggested to be an effective treatment, but careful consideration is required in each individual case.
在涉及穿支动脉作为供血动脉的脑动静脉畸形（AVM）病例中，手术切除时止血困难，术后可能发生出血。若有可能，应进行术前栓塞。然而，当前脉络膜动脉（AChA）作为供血动脉时，栓塞风险特别高，且很少有报告描述这种情况。作者报告了5例由同一术者通过AChA进行术前栓塞的AVM治疗结果，并结合文献回顾描述了该技术。
5例患者（3例男性，2例女性；平均年龄43.4岁[28 - 68岁]）中，1例表现为出血，2例为癫痫，另外2例分别为头痛和三叉神经痛。病变位于额叶1例，颞叶4例。根据斯佩茨勒 - 马丁（SM）分级标准，4例为Ⅲ级，1例为Ⅳ级。4例病变巢内累及功能区。由于所有病例均为高级别AVM，因此计划进行多模式治疗。作者认为通过AChA进行术前栓塞可降低总体治疗风险，并进行了术前栓塞。所有病例均可行栓塞，3例通过AChA血管造影未显示AVM。2例AChA血流减少。所有病例栓塞后立即清醒，栓塞后无1例出现神经症状。栓塞后CT或MRI显示2例有无症状性梗死。AVM均安全顺利切除，包括止血。
在本系列研究中，无并发症发生，栓塞操作相对安全。通过AChA进行栓塞被认为是一种有效的治疗方法，但需对每个病例进行仔细考虑。
