Atypical venous drainage system and distinct vascular characteristics in pediatric intracerebral hemorrhage caused by multiple micro arteriovenous malformations.

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY
Child's Nervous System Pub Date : 2024-12-01 Epub Date: 2024-10-04 DOI:10.1007/s00381-024-06636-w
Katsuya Saito, Go Ikeda, Yoshimitsu Akutsu, Hideyuki Kano, Hiroyoshi Akutsu
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引用次数: 0

Abstract

Background: Hemorrhagic brain micro-arteriovenous malformations (micro-AVMs) are considered to constitute a relatively significant portion of pediatric AVMs, though they are often associated with a low bleeding rate, as seen in hereditary hemorrhagic telangiectasia, which frequently involves multiple micro-AVMs. We present a rare case of a 10-year-old girl with multiple hemorrhagic micro-AVMs. Intraoperative findings during the emergency operation for hematoma evacuation and post-operative superselective angiography highlighted the unique angioarchitecture of three micro-AVMs (two lesions in the superficial areas and one lesion in the deep-seated area) and the atypical bleeding source due to the complex congestive venous drainage system. One micro-AVM was successfully occluded by a transarterial emboliozation, and remaining two micro-AVMs underwent gamma knife irradiation as a salvage therapy.

Conclusion: Superselective angiography is crucial for detecting micro-AVMs, offering detailed insights into small, localized abnormal vascular drainage systems, and guiding therapeutic strategy. Additionally, micro-AVM-associated unique vascular hypersensitivity, such as vasospasm, requires careful consideration, as invasive procedures may significantly alter the visibility of the entire micro-AVM network.

多发性微动静脉畸形导致的小儿脑内出血的非典型静脉引流系统和独特的血管特征。
背景:出血性脑微小动静脉畸形(micro-AVMs)被认为在小儿动静脉畸形中占比较大的比例,尽管它们通常与低出血率有关,如遗传性出血性毛细血管扩张症(经常涉及多个微小动静脉畸形)。我们报告了一例罕见的 10 岁女孩多发性出血性微小血管瘤病例。术中紧急血肿清除手术和术后超选择性血管造影术的发现,凸显了三个微小血管瘤(两个病变位于浅表区域,一个病变位于深层区域)独特的血管结构,以及复杂的充血性静脉引流系统导致的非典型出血源。经动脉栓塞术成功堵塞了一个微小血管瘤,其余两个微小血管瘤接受了伽马刀照射作为挽救治疗:结论:超选择性血管造影对于检测微小血管瘤至关重要,它能详细了解局部小的异常血管引流系统,并指导治疗策略。此外,与微小血管瘤相关的独特血管超敏反应(如血管痉挛)也需要慎重考虑,因为侵入性手术可能会显著改变整个微小血管瘤网络的可见度。
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来源期刊
Child's Nervous System
Child's Nervous System 医学-临床神经学
CiteScore
3.00
自引率
7.10%
发文量
322
审稿时长
3 months
期刊介绍: The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.
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