Ivanov Kiril, Atsev Stanimir, Petrov Petar-Preslav, Ilyov Ilko, Penchev Plamen
Faculty of Medicine, Medical University of Plovdiv, Plovdiv, BGR.
Cardiac Surgery Clinic, Passau Clinic, Passau, DEU.
Cureus. 2024 May 17;16(5):e60499. doi: 10.7759/cureus.60499. eCollection 2024 May.
Cerebral arteriovenous malformations (cAVMs) are developmental pathologic lesions of the blood vessels of the brain in which multiple arteries shunt blood directly into the venous drainage network. They are lesions with an unclear etiology and, if left untreated, can bear significant risks of complications such as migraines, seizures, neurological deficits, and intracranial hemorrhages. The diagnosis is based on several imaging methods, with angiography being the primary method. Treatment modalities include microsurgery, radiosurgery, embolization with the intent of obliteration, and various multidisciplinary approaches. We aim to introduce the case of an adult female patient with symptomatic cAVM who underwent partial endovascular embolization of the lesion and evaluate her recovery and the overall reliability of her treatment modality. A 22-year-old female patient has presented to the Neurosurgery Clinic with clinical manifestations with photosensitive seizures, migraines, and a history of sleep disturbances persisting for a period of one year. An appointed MRI and angiography revealed the presence of a glomerular cAVM of the anterior parietal branch of the middle cerebral artery located within the intraparietal sulcus of the left cerebral hemisphere (Spetzler-Martin grade 2). The venous drainage of the malformation led to a loss of nutrients in the surrounding brain parenchyma (a steal phenomenon), causing the seizures. The patient successfully underwent transarterial endovascular embolization with Onyx, which proved to be partial on a postoperative angiography, and refused further embolization procedures. There were no postoperative complications to be mentioned. The patient reported no seizures or sleep disturbances at the 12-month follow-up, with sporadic weak headaches remaining. cAVMs remain a pathology with significant morbidity and mortality when undiagnosed. Symptomatic cAVMs leading to a steal phenomenon and seizures can be reliably managed via endovascular embolization alone when the malformation has an appropriate angioarchitecture, location, size, and a low Spetzler-Martin score. However, further inquiry is required into the use of partial embolization in cases where further multiple-stage embolization procedures are declined and/or complete occlusion of the lesion is unfeasible. This case report emphasizes that partial endovascular embolization can be successfully utilized as a treatment modality for the symptoms caused by a steal phenomenon of the venous drainage of a cAVM, such as seizure disorders and migraines, in the rare instance when multiple-stage embolization is declined by the patient and occlusion of the lesion remains subtotal.
脑动静脉畸形（cAVM）是脑部血管的发育性病理病变，其中多条动脉将血液直接分流到静脉引流网络中。它们是病因不明的病变，如果不进行治疗，可能会承受偏头痛、癫痫、神经功能缺损和颅内出血等并发症的重大风险。诊断基于多种成像方法，血管造影是主要方法。治疗方式包括显微手术、放射外科、旨在闭塞的栓塞以及各种多学科方法。我们旨在介绍一例有症状的cAVM成年女性患者的病例，该患者接受了病变的部分血管内栓塞治疗，并评估她的恢复情况以及治疗方式的总体可靠性。一名22岁女性患者因光敏性癫痫、偏头痛和持续一年的睡眠障碍病史就诊于神经外科诊所。指定的MRI和血管造影显示，在左脑半球顶内沟内存在位于大脑中动脉顶前分支的肾小球样cAVM（Spetzler-Martin 2级）。畸形的静脉引流导致周围脑实质营养物质流失（盗血现象），从而引发癫痫。患者成功接受了使用Onyx的经动脉血管内栓塞治疗，术后血管造影显示为部分栓塞，患者拒绝进一步的栓塞程序。术后未提及并发症。在12个月的随访中，患者报告无癫痫发作或睡眠障碍，仅偶尔有轻微头痛。未诊断出的cAVM仍然是一种具有显著发病率和死亡率的病理状况。当畸形具有合适的血管结构、位置、大小且Spetzler-Martin评分较低时，导致盗血现象和癫痫发作的有症状cAVM仅通过血管内栓塞即可得到可靠治疗。然而，对于拒绝进一步多阶段栓塞程序和/或病变无法完全闭塞的情况，使用部分栓塞的情况还需要进一步研究。本病例报告强调，在患者拒绝多阶段栓塞且病变闭塞仍不完全的罕见情况下，部分血管内栓塞可成功用作治疗cAVM静脉引流盗血现象引起的症状（如癫痫发作和偏头痛）的治疗方式。
