Morgan M K, Day M J, Little N, Grinnell V, Sorby W
Department of Neurosurgery, Royal North Shore Hospital, St. Leonards, Australia.
J Neurosurg. 1995 Feb;82(2):296-9. doi: 10.3171/jns.1995.82.2.0296.
The authors report two cases of treatment by intraarterial papaverine of cerebral vasospasm complicating the resection of an arteriovenous malformation (AVM). Both cases had successful reversal of vasospasm documented on angiography. In the first case sustained neurological improvement occurred, resulting in a normal outcome by the time of discharge. In the second case, neurological deterioration occurred with the development of cerebral edema. This complication was thought to be due to normal perfusion pressure breakthrough, on the basis of angiographic arterial vasodilation and increased cerebral blood flow. These two cases illustrate an unusual complication of surgery for AVMs and demonstrate that vasospasm (along with intracranial hemorrhage, venous occlusion, and normal perfusion pressure breakthrough) should be considered in the differential diagnosis of delayed neurological deterioration following resection of these lesions. Although intraarterial papaverine may be successful in dilating spastic arteries, it may also result in pathologically high flows following AVM resection. However, this complication has not been seen in our experience of treating aneurysmal subarachnoid hemorrhage by this technique.
作者报告了两例采用动脉内罂粟碱治疗动静脉畸形（AVM）切除术后并发脑血管痉挛的病例。两例血管痉挛均在血管造影时成功逆转。第一例出现持续的神经功能改善，出院时恢复正常。第二例出现神经功能恶化并伴有脑水肿。基于血管造影显示动脉扩张和脑血流量增加，这种并发症被认为是由于正常灌注压突破所致。这两例病例说明了AVM手术的一种不寻常并发症，并表明在这些病变切除术后延迟性神经功能恶化的鉴别诊断中应考虑血管痉挛（以及颅内出血、静脉闭塞和正常灌注压突破）。虽然动脉内罂粟碱可能成功扩张痉挛动脉，但在AVM切除术后也可能导致病理性高流量。然而，在我们采用该技术治疗动脉瘤性蛛网膜下腔出血的经验中尚未见到这种并发症。
