Nagasaka S, Fukushima T, Goto K, Ohjimi H, Iwabuchi S, Maehara F
Department of Neurosurgery, School of Medicine, Fukuoka University, Japan.
Neurosurgery. 1996 Apr;38(4):671-7; discussion 677.
We report seven patients with scalp arteriovenous malformations, including two patients with lesions > 10 cm in diameter, who were successfully treated. The principal complaint of each patient was a deforming mass. Each of four patients had a history of blunt traumatic injury. The lesions, each consisting of the nidus, feeders, and draining veins, evolved in all patients. The nidus consisted of fistulae, which exhibited various angioarchitectures as revealed by angiography. A hemangiomatous component was histologically recognized in one patient. In five patients, in whom the lesions were relatively small and whose nidi included only large fistulae, the malformations were remedied by surgical intervention alone or were cured with embolization alone using liquid adhesives. In the two patients with lesions > 10 cm, the nidi consisted of numerous large fistulae and plexiform fistulae in one patient and plexiform fistulae and a hemangiomatous component in the other patient. These patients were treated with a combination of transarterial embolization and surgical intervention. Preoperative embolization greatly reduced blood loss during resection. Total excision and scalp reconstruction using a soft tissue expander were performed in both patients. The cosmetic results were excellent in all of the patients, and no recurrence has been recognized during the follow-up period, which ranges from 31 to 99 months. The treatment of scalp arteriovenous malformations should strive to improve deforming features and to attain a permanent cure. Because each nidus includes a variety of anomalous angioarchitectural features, there should be different means and a combination of treatments for each patient. Embolization alone could be adequate treatment in relatively small lesions, the nidi of which consist only of several large fistulae. For malformations with more extensive, large fistulae or with anomalous components other than large fistulae, a combined endovascular and surgical approach and scalp reconstruction seems to be the best treatment.
我们报告了7例头皮动静脉畸形患者，其中包括2例直径大于10 cm的病变患者，他们均得到了成功治疗。每位患者的主要诉求均为畸形肿块。4例患者有钝性外伤史。所有患者的病变均由瘤巢、供血动脉和引流静脉组成。瘤巢由瘘管构成，血管造影显示其具有多种血管构筑。1例患者在组织学上发现有血管瘤成分。5例病变相对较小且瘤巢仅包含大的瘘管的患者，通过单纯手术干预得到了纠正，或使用液体黏合剂单独栓塞治愈。在2例病变大于10 cm的患者中，1例患者的瘤巢由大量大的瘘管和丛状瘘管组成，另1例患者的瘤巢由丛状瘘管和血管瘤成分组成。这些患者接受了经动脉栓塞和手术干预相结合的治疗。术前栓塞大大减少了切除术中的出血量。2例患者均进行了全切除，并使用软组织扩张器进行了头皮重建。所有患者的美容效果均极佳，在31至99个月的随访期内均未发现复发。头皮动静脉畸形的治疗应致力于改善畸形特征并实现永久治愈。由于每个瘤巢都包含各种异常的血管构筑特征，因此应对每位患者采用不同的治疗方法及联合治疗。对于相对较小的病变，若其瘤巢仅由几个大的瘘管组成，单独栓塞可能是足够的治疗方法。对于具有更广泛、大的瘘管或除大的瘘管外还有异常成分的畸形，血管内和手术联合治疗及头皮重建似乎是最佳治疗方法。
