背景:扩散张量成像(DTI)可以表征受脑动静脉畸形(AVM)影响的雄辩白质束。然而,由于存在血液制品,DTI在破裂病例中的解释可能很困难。作者介绍了皮质脊髓束(CST)中小儿AVM破裂的情况,并讨论了DTI在不同时间点如何告知治疗。
方法:一名9岁女性出现突发性头痛和左偏瘫。她被发现有Spetzler-Martin三级,在右侧尾状核和中心半卵中补充I级AVM,具有消除和相应的降低的分数各向异性(FA),纤维密度(FD),和DTI上相邻CST的道计数(TC)。患者保持稳定,并计划在6周后进行选择性切除术以促进血肿吸收。6周后,重复DTI显示完整CST纤维内的一部分nidus,FA有一致的改善,FD,和TC。考虑到Nidus的位置,CST完整性,和运动功能恢复,手术被推迟,有利于立体定向放射外科手术。
结论:在破裂的AVM中,DTI最初可能会创建不完整的图片和关于白质束完整性的错误假设。如果延迟治疗适当,则应重复DTI,以确保做出明智的决定并防止可避免的永久性神经功能缺损。https://thejns.org/doi/10.3171/CASE24225.
BACKGROUND: Diffusion tensor imaging (DTI) can characterize eloquent white matter tracts affected by brain arteriovenous malformations (AVMs). However, DTI interpretation can be difficult in ruptured cases due to the presence of blood products. The authors present the case of a ruptured pediatric AVM in the corticospinal tract (CST) and discuss how DTI at different time points informed the treatment.
METHODS: A 9-year-old female presented with a sudden headache and left hemiparesis. She was found to have a Spetzler-Martin grade III, Supplementary grade I AVM in the right caudate and centrum semiovale, with obliteration and corresponding reduced fractional anisotropy (FA), fiber density (FD), and tract count (TC) of the adjacent CST on DTI. The patient remained stable and was scheduled for elective resection following a 6-week period to facilitate hematoma resorption. After 6 weeks, repeat DTI showed part of the nidus within intact CST fibers with concordant improvement in FA, FD, and TC. Considering the nidus location, CST integrity, and motor function recovery, surgery was deferred in favor of stereotactic radiosurgery.
CONCLUSIONS: In ruptured AVMs, DTI may initially create an incomplete picture and false assumptions about white matter tract integrity. DTI should be repeated if delayed treatment is appropriate to ensure informed decision-making and prevent avoidable permanent neurological deficits. https://thejns.org/doi/10.3171/CASE24225.