Inai Soichi, Sano Noritaka, Takeuchi Yasuhide, Makino Yasuhide, Yamamoto Hattori Etsuko, Takada Shigeki, Tanji Masahiro, Mineharu Yohei, Arakawa Yoshiki
Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.
J Neurosurg Case Lessons. 2024 Dec 2;8(23). doi: 10.3171/CASE24570.
Postoperative symptom exacerbation after resection of cerebral cavernous malformations (CCMs) is usually due to surgical damage to the eloquent areas or venous outflow obstruction from injury to a developmental venous anomaly (DVA).
A 21-year-old right-handed female presented with headache, right limb weakness, and aphasia. Magnetic resonance imaging (MRI) revealed a 3.5-cm CCM with significant perilesional edema in the middle frontal gyrus. Despite medical treatment, her weakness worsened, necessitating emergency resection. Imaging revealed no DVA or venous obstructions. Histopathological examination revealed marked neutrophil infiltration, indicating noninfectious inflammation. One week postoperatively, MRI revealed increased edema around the resection site. Although the aphasia improved, paralysis (manual muscle testing grade 3) persisted, prompting betamethasone administration. The symptoms rapidly improved over 10 days, and the patient was discharged symptom free on day 20 with no recurrence thereafter.
Patients with prolonged postoperative deficits after CCM resection can experience noninfectious inflammation. Anti-inflammatory treatments such as corticosteroids may be necessary in similar cases with poor recovery from edema and symptoms. https://thejns.org/doi/10.3171/CASE24570.
脑海绵状血管畸形（CCM）切除术后症状加重通常是由于手术损伤了功能区或因发育性静脉异常（DVA）损伤导致静脉流出道梗阻。
一名21岁右利手女性，出现头痛、右肢无力和失语症状。磁共振成像（MRI）显示额叶中回有一个3.5厘米的CCM，病灶周围有明显水肿。尽管进行了药物治疗，但其无力症状仍加重，因此需要紧急手术切除。影像学检查未发现DVA或静脉梗阻。组织病理学检查显示有明显的中性粒细胞浸润，提示为非感染性炎症。术后一周，MRI显示切除部位周围水肿加重。虽然失语症状有所改善，但瘫痪症状（徒手肌力测试3级）仍然存在，遂给予倍他米松治疗。症状在10天内迅速改善，患者在第20天无症状出院，此后未复发。
CCM切除术后出现长期功能缺损的患者可能会发生非感染性炎症。在类似因水肿和症状恢复不佳的病例中，可能需要使用皮质类固醇等抗炎治疗。https://thejns.org/doi/10.3171/CASE24570
