脑动静脉畸形(cAVM)是脑血管的发育性病理损害,其中多个动脉将血液直接分流到静脉引流网络中。它们是病因不清楚的病变,如果不及时治疗,可能承受偏头痛等并发症的重大风险,癫痫发作,神经功能缺损,颅内出血.诊断基于几种成像方法,血管造影是主要方法。治疗方式包括显微外科手术,放射外科,意图闭塞的栓塞,和各种多学科方法。我们旨在介绍一名有症状的cAVM成年女性患者的病例,该患者接受了病变的部分血管内栓塞治疗,并评估其恢复情况和治疗方式的总体可靠性。一名22岁的女性患者出现在神经外科诊所,临床表现为光敏性癫痫发作,偏头痛,和持续一年的睡眠障碍史。指定的MRI和血管造影显示,位于左脑半球顶内沟内的大脑中动脉前顶支的肾小球cAVM(Spetzler-Martin2级)。畸形的静脉引流导致周围脑实质中的营养损失(偷窃现象),导致癫痫发作。患者成功接受了Onyx经动脉血管内栓塞,在术后血管造影中被证明是局部的,并拒绝进一步的栓塞手术。术后无并发症。患者在12个月的随访中没有报告癫痫发作或睡眠障碍。伴随着零星的微弱头痛。cAVM在未诊断时仍然是具有显著发病率和死亡率的病理学。当畸形具有适当的血管结构时,仅通过血管内栓塞就可以可靠地管理导致盗血现象和癫痫发作的症状性cAVM。location,尺寸,和低Spetzler-Martin得分.然而,在进一步的多阶段栓塞手术被拒绝和/或病变完全闭塞不可行的情况下,需要进一步调查部分栓塞的使用情况.该病例报告强调,部分血管内栓塞可以成功地用作由cAVM静脉引流的盗血现象引起的症状的治疗方式,如癫痫和偏头痛,在极少数情况下,当患者拒绝多阶段栓塞并且病变的闭塞仍然是次要的。
Cerebral arteriovenous malformations (cAVMs) are developmental pathologic lesions of the blood vessels of the brain in which multiple arteries shunt blood directly into the venous drainage network. They are lesions with an unclear etiology and, if left untreated, can bear significant risks of complications such as migraines, seizures, neurological deficits, and intracranial hemorrhages. The diagnosis is based on several imaging methods, with angiography being the primary method. Treatment modalities include microsurgery, radiosurgery, embolization with the intent of obliteration, and various multidisciplinary approaches. We aim to introduce the case of an adult female patient with symptomatic cAVM who underwent partial endovascular embolization of the lesion and evaluate her recovery and the overall reliability of her treatment modality. A 22-year-old female patient has presented to the Neurosurgery Clinic with clinical manifestations with photosensitive seizures, migraines, and a history of sleep disturbances persisting for a period of one year. An appointed MRI and angiography revealed the presence of a glomerular cAVM of the anterior parietal branch of the middle cerebral artery located within the intraparietal sulcus of the left cerebral hemisphere (Spetzler-Martin grade 2). The venous drainage of the malformation led to a loss of nutrients in the surrounding brain parenchyma (a steal phenomenon), causing the seizures. The patient successfully underwent transarterial endovascular embolization with Onyx, which proved to be partial on a postoperative angiography, and refused further embolization procedures. There were no postoperative complications to be mentioned. The patient reported no seizures or sleep disturbances at the 12-month follow-up, with sporadic weak headaches remaining. cAVMs remain a pathology with significant morbidity and mortality when undiagnosed. Symptomatic cAVMs leading to a steal phenomenon and seizures can be reliably managed via endovascular embolization alone when the malformation has an appropriate angioarchitecture, location, size, and a low Spetzler-Martin score. However, further inquiry is required into the use of partial embolization in cases where further multiple-stage embolization procedures are declined and/or complete occlusion of the lesion is unfeasible. This case report emphasizes that partial endovascular embolization can be successfully utilized as a treatment modality for the symptoms caused by a steal phenomenon of the venous drainage of a cAVM, such as seizure disorders and migraines, in the rare instance when multiple-stage embolization is declined by the patient and occlusion of the lesion remains subtotal.