Suga T, Goto H, Yoshioka K, Sano M
Department of Neurosurgery, Kamaishi Municipal Hospital.
No Shinkei Geka. 1995 Jul;23(7):609-13.
A case of mixed cerebrovascular malformation of the brainstem with pontine hemorrhage is reported. The mixed cerebrovascular malformation was composed of medullary venous malformation, one hemorrhagic and another non-hemorrhagic mass. The latter masses were thought to be cavernous venous malformations by their MR findings. The medullary venous malformation drained to the anterior pontomesencephalic vein through a transpontine vein. A 70-year-old man, complaining of aggravation of left hemiparesis, was admitted to our department. His past history included traumatic cervical myelopathy and diabetic neuropathy. CT revealed a pontine hemorrhage with linear enhancement. Depending on MRI findings, the hemorrhage was thought to be an intratumoral hemorrhage within the cavernous venous malformation. Cerebral angiogram demonstrated medullary venous malformation. The malformation drained to the anterior pontomesencephalic vein through a transpontine vein. The linear enhancement was the transpontine vein itself. Medullary venous malformations in the brainstem are rare. With MRI, the transpontine vein is thought to be a characteristic feature of medullary venous malformation of the brainstem. We suggest that most cases of hemorrhagic medullary venous malformations are mixed cerebrovascular malformations. We emphasize the need for precise examination of other types of vascular lesions coexisting with medullary venous malformations.
报告一例脑干混合性脑血管畸形伴桥脑出血。该混合性脑血管畸形由延髓静脉畸形、一个出血性肿块和另一个非出血性肿块组成。根据磁共振成像（MR）表现，后两个肿块被认为是海绵状静脉畸形。延髓静脉畸形通过一条经桥静脉引流至桥前脑静脉。一名70岁男性，因左侧偏瘫加重而入院。他既往有创伤性颈髓病和糖尿病性神经病变史。计算机断层扫描（CT）显示桥脑出血伴线状强化。根据磁共振成像结果，出血被认为是海绵状静脉畸形内的肿瘤内出血。脑血管造影显示延髓静脉畸形。该畸形通过一条经桥静脉引流至桥前脑静脉。线状强化是经桥静脉本身。脑干延髓静脉畸形罕见。通过磁共振成像，经桥静脉被认为是脑干延髓静脉畸形的一个特征性表现。我们认为大多数出血性延髓静脉畸形病例是混合性脑血管畸形。我们强调需要对与延髓静脉畸形共存的其他类型血管病变进行精确检查。
