PDF(Pubmed)
Abstract：
Brain arteriovenous malformations (AVM) present complex treatment decisions, particularly for low-grade AVM where surgical resection is often considered the standard. This case report emphasizes the importance of patient preferences and cultural considerations in selecting endovascular embolization over traditional surgical approaches for Spetzler-Martin Grade I AVM management, highlighting the evolving practice of patient-centered care in neurointervention. A 30-year-old male presented with recurrent seizures, characterized by a sudden onset of headache followed by speech arrest, without any preceding medical history of neurological deficits. Initial physical examination revealed no focal neurological deficits. Non-contrast computed tomography, magnetic resonance imaging, and magnetic resonance angiography suggested an AVM involving the cortical-subcortical regions of the left frontal lobe, measuring approximately 1.7 × 2.6 × 1.5 cm, fed by the left middle cerebral artery M3 segment, and draining into the superior sagittal sinus. Spetzler-Martin Grade I classification was confirmed via digital subtraction angiography. Given the patient\'s strong preference against invasive procedures, driven by personal and cultural beliefs, endovascular embolization was selected as the treatment strategy. Post-embolization, the patient showed marked symptomatic improvement with no evidence of residual AVM on follow-up imaging, and no postprocedure complications were reported. This case highlights the importance of considering patient preferences in AVM treatment planning, illustrating that endovascular embolization can be an effective and less invasive alternative to surgery in selected patients, reinforcing the need for personalized, patient-centered approaches in neurointerventional care.
摘要：
脑动静脉畸形（AVM）提出了复杂的治疗决定，特别是对于低级别AVM，手术切除通常被认为是标准。该病例报告强调了在选择血管内栓塞术而不是传统的Spetzler-MartinI级AVM治疗方法时，患者偏好和文化考虑因素的重要性。强调在神经干预中不断发展的以患者为中心的护理实践。一名30岁男性反复发作,以突然发作的头痛为特征，然后是言语停滞，没有任何神经缺陷病史.最初的体格检查显示没有局灶性神经功能缺损。非对比计算机断层扫描,磁共振成像，磁共振血管造影提示AVM累及左额叶皮质-皮质下区域,大约1.7×2.6×1.5厘米，由左大脑中动脉M3段喂养，排入上矢状窦.通过数字减影血管造影确认了Spetzler-MartinI级分类。鉴于患者强烈反对侵入性手术，受个人和文化信仰的驱使，选择血管内栓塞作为治疗策略.栓塞后,患者表现出明显的症状改善，随访影像中没有残留AVM的证据，没有报告术后并发症。这个案例强调了在AVM治疗计划中考虑患者偏好的重要性，说明血管内栓塞可以是一个有效的和较小的创伤替代手术在选定的患者，加强对个性化的需求，以患者为中心的神经介入治疗方法。
