背景:血管畸形(VMs)是由于血管生成过程中的错误而产生的,通常在出生时就存在,但直到出生后才会变得明显。然而,头部和面部的巨型VM并不常见,报告的病例很少,和他们的手术干预的预后尚不清楚。
方法:一名12岁女孩因右侧颞叶头皮增大而入院。入院后,脑动脉的计算机断层扫描(CT)血管造影显示右咬合间隙和右颞动脉静脉畸形。此外,脑血管造影显示右颞叶VM有多个血管供血。患者接受手术以移除畸形血管和侵蚀的头骨。手术后两小时,病人的右瞳孔扩大了,颅骨的紧急CT扫描显示切口下右侧硬膜下血肿,被第二次手术紧急移除。手术后,我们连续给予抗生素抗感染治疗,病人恢复良好,两周后出院。
结论:手术切除巨大血管瘤是有风险的,应做好术前(包括介入栓塞)和术中准备。
BACKGROUND: Vascular malformations (VMs) arise as a result of errors in the process of angiogenesis and are usually present at birth, but may not become apparent until after birth. However, giant VMs of the head and face are uncommon, with few reported cases, and the prognosis for their surgical intervention is unclear.
METHODS: A 12-year-old girl was admitted to the hospital with findings of an enlarged right temporal scalp. After admission, computed tomography (CT) angiography of cerebral ateries showed a right occlusal gap and a right temporal artery venous malformation. Furthermore, cerebral angiography showed a right temporal lobe VM with multiple vessels supplying blood. The patient underwent surgery to remove the malformed vessels and the eroded skull. Two hours after the surgery, the patient\'s right pupil was dilated, and an urgent CT scan of the skull showed a right subdural haematoma under the incision, which was urgently removed by a second operation. After surgery, we gave continuous antibiotic anti-infection treatment, and the patient recovered well and was discharged two weeks later.
CONCLUSIONS: Surgical removal of giant haemangiomas is risky and adequate preoperative (including interventional embolisation) and intraoperative preparations should be made.