Halatsch M E, Rustenbeck H H, Jansen J
Department of Neurosurgery, University of Göttingen, Federal Republic of Germany.
Acta Neurochir (Wien). 1997;139(1):82-5. doi: 10.1007/BF01850873.
We report a case of moyamoya disease (MMD) associated with arteriovenous malformation (AVM). The 30-year-old female patient presented with left-hemispheric transient ischaemic attacks (TIAs) involving dysphasia and right-sided hemiparesis. CT-scan and lumbar puncture showed no evidence of intracranial haemorrhage. Cerebral angiography revealed typical moyamoya vessels and occlusion of multiple cerebral arteries with consecutive collateral blood supply. Moreover, a left-parietal AVM with a diameter of approximately 2 cm was detected. An extra-intracranial arterial bypass (EIAB) connecting the left superficial temporal artery (STA) with a cortical branch of the left middle cerebral artery (MCA) was performed (STA-MCA anastomosis) and yielded subsequent resolution of the neurological deficit. Nine months post-operatively neurological deficits similar to those of the initial presentation recurred. Repeated angiography suggested comparatively increased AVM blood flow, and successful extirpation of the AVM gradually re-established almost full functional ability. However, deterioration of the neurological condition developed again. We herewith present the first European case of moyamoya disease associated with arteriovenous malformation and report the clinical course under an alternative neurosurgical treatment consisting of STA-MCA anastomosis and delayed extirpation of the AVM.
我们报告一例与动静脉畸形（AVM）相关的烟雾病（MMD）病例。该30岁女性患者出现左侧半球短暂性脑缺血发作（TIA），伴有言语困难和右侧偏瘫。CT扫描和腰椎穿刺未发现颅内出血迹象。脑血管造影显示典型的烟雾病血管以及多条脑动脉闭塞并伴有连续的侧支血液供应。此外，还检测到一个直径约2厘米的左顶叶AVM。进行了一项将左颞浅动脉（STA）与左大脑中动脉（MCA）的皮质分支相连的颅外-颅内动脉搭桥术（EIAB）（STA-MCA吻合术），随后神经功能缺损得到缓解。术后九个月，出现了与初始表现相似的神经功能缺损复发。重复血管造影显示AVM血流相对增加，成功切除AVM后逐渐恢复了几乎全部的功能能力。然而，神经状况再次恶化。我们在此呈现欧洲首例与动静脉畸形相关的烟雾病病例，并报告了一种由STA-MCA吻合术和延迟切除AVM组成的替代神经外科治疗方案下的临床病程。
