A case of urgent neurosurgical treatment of intracerebral hemorrhage due to rupture of a cavernous hemangioma because of the progressive clinical deterioration

M. S. Gudym, I. Bortnik, M. Vyval
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Abstract

Cavernous hemangiomas (CH) are benign vascular lesions of the central nervous system, which are thin-walled vascular sinusoids without smooth muscle with hemosiderin deposits. CH is the second (after aneurysms) most frequent incidental vascular finding on magnetic resonance imaging of the brain, with a prevalence of 1 case per 625. CHs can be asymptomatic, cause seizures, intracranial hemorrhage due to rupture, or be the cause of focal neurological deficits without signs of previous hemorrhage. Intracranial hemorrhages of varying degrees of severity can occur both in supratentorial and infratentorial CH. The annual frequency of bleeding in CH is 0.3‒2.4 %, but they are rarely fatal, especially with supratentorial localization. Indications and timing of surgical intervention in CH are the question of debate.The presented case demonstrates the possibility of intracerebral hematoma formation as a result of the rupture of one of the multiple supratentorial CHs, which led to clinical deterioration and required urgent neurosurgical treatment. Although such clinical course is rare, it should be taken into account when planning treatment and informing patients with CH. A 62-year-old woman fell ill suddenly. The disease manifested with the onset of headache and left-sided hemiplegia At the local hospital, magnetic resonance imaging of the brain was performed and an intracranial hemorrhage in the right subcortical area due to rupture of the CH, and another asymptomatic CH in the triangle of the left lateral ventricle, ware founded. The patient initially received conservative therapy, but 48 hours after the onset of the disease, the patient's consciousness declined to 10 GCS points, and she was urgently transferred to the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine», and an emergency operation was performed for removal of intracerebral hematoma and CH. Histological examination confirmed the diagnosis «cavernous hemangioma». The postoperative course was uneventful, and the neurological deficit regressed to mild left-sided hemiparesis. Indications and timing of surgical intervention in CH remain uncertain.
一例海绵状血管瘤破裂脑出血因临床进展恶化而紧急神经外科治疗的病例
海绵状血管瘤(CH)是中枢神经系统的良性血管病变,为薄壁血管窦,无平滑肌,含铁血黄素沉积。CH是脑磁共振成像中第二常见的偶然血管发现(仅次于动脉瘤),发病率为1 / 625。CHs可以是无症状的,引起癫痫发作,颅内出血由于破裂,或局灶性神经功能缺损的原因没有出血的迹象。幕上和幕下CH均可发生不同程度严重程度的颅内出血。每年出血的频率为0.3% - 2.4%,但很少致命,特别是幕上定位。慢性阻塞性肺疾病手术干预的适应症和时机是有争议的问题。本病例显示多个幕上CHs之一破裂可能导致脑内血肿形成,导致临床恶化,需要紧急神经外科治疗。虽然这样的临床过程很少见,但在计划治疗和告知CH患者时应考虑到这一点。本病表现为头痛和左侧偏瘫,在当地医院进行脑磁共振成像,发现右侧皮质下区因CH破裂而颅内出血,并在左侧侧脑室三角形发现另一无症状CH。患者最初接受保守治疗,但发病48小时后,患者意识下降至10 GCS点,紧急转至SO“乌克兰NAMS血管内神经放射学科学实践中心”,紧急手术切除脑内血肿和CH。组织学检查证实诊断为“海绵状血管瘤”。术后过程顺利,神经功能缺损恢复为轻度左侧偏瘫。CH的适应症和手术干预时间仍不确定。
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