Miyasaka Y, Kurata A, Tokiwa K, Tanaka R, Yada K, Ohwada T
Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, Japan.
Stroke. 1994 Feb;25(2):504-7. doi: 10.1161/01.str.25.2.504.
Recent radiological studies have shown that arteriovenous malformations with impaired venous drainage may be susceptible to hemorrhage. To evaluate this hypothesis using a hemodynamic approach, we measured intravascular pressure during surgery in three patients with arteriovenous malformation.
In three patients we measured intravascular pressures in the draining venous system and the feeding arteries simultaneously before removal of arteriovenous malformations with marked segmental stenotic or occlusive draining veins and evidence of hemorrhage. The draining vein pressures at prestenotic (or preocclusive) sites in the three patients were 38, 25, and 40 mm Hg, respectively, all significantly above the normal cortical venous pressure, whereas pressure measurements in poststenotic sites and the sagittal sinus pressure in the venous drainage system approached normal values. The feeding artery pressures in the patients were lower than normal cortical artery pressure because of the arteriovenous shunt.
Intraoperative vascular pressure measurements support the hypothesis that arteriovenous malformations with impaired venous drainage may be associated with a local increase in venous pressure and thus may be susceptible to hemorrhage.
近期的放射学研究表明，静脉引流受损的动静脉畸形可能易发生出血。为了用血液动力学方法评估这一假说，我们在3例动静脉畸形患者手术过程中测量了血管内压力。
在3例有明显节段性狭窄或闭塞性引流静脉且有出血迹象的动静脉畸形患者中，我们在切除动静脉畸形前同时测量了引流静脉系统和供血动脉的血管内压力。3例患者狭窄前（或闭塞前）部位的引流静脉压力分别为38、25和40 mmHg，均显著高于正常皮质静脉压力，而狭窄后部位的压力测量值及静脉引流系统的矢状窦压力接近正常值。由于动静脉分流，患者的供血动脉压力低于正常皮质动脉压力。
术中血管压力测量结果支持以下假说，即静脉引流受损的动静脉畸形可能与局部静脉压力升高有关，因此可能易发生出血。
