胼胝体的复杂动静脉畸形:手术的细微差别

M. Ismail, Saja A. Albanaa, Ali M. Neamah, Noor F. Hassan, Yasir A. Mohialdeen, Awfa Aktham Abdulateef, Samer S. Hoz
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引用次数: 0

摘要

胼胝体动静脉畸形(CC-AVMs)是一种罕见且具有挑战性的病变,占所有脑动静脉畸形的8-9%。它们与复发性出血的高风险相关,历史上被认为是不可手术的。本病例报告描述了在立体定向放射手术失败后成功切除高级别CC-AVM的病例。一名19岁女性与前CC-AVM提出癫痫发作,尽管在三重抗癫痫药。该患者曾因脑室内出血接受保守治疗,并因AVM接受立体定向放射治疗。术前影像学显示胼胝体膝和颈部有一个5厘米的CC-AVM,并在脑室内延伸至第三脑室。根据Spetzler-Martin评分系统,AVM分为4级,根据补充评分系统分为6级。病变通过前半球间经胼胝体入路暴露,并进行显微手术解剖。确定大引流静脉,凝固,断开,并与病灶一起切除。手术总时间12.5 h,术后无神经功能缺损,第10天出院。术后磁共振成像证实完全切除,患者随访18个月无癫痫发作。本病例报告证明了非手术治疗失败的高级别cc - avm完全手术切除的可行性。在这些具有挑战性的病例中,仔细的手术计划和技术可以导致良好的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Complex arteriovenous malformation of the corpus callosum: Surgical nuances
Arteriovenous malformations of the corpus callosum (CC-AVMs) are rare and challenging lesions, accounting for 8–9% of all cerebral AVMs. They are associated with a high risk of recurrent hemorrhage and historically were considered inoperable. This case report describes the successful surgical resection of a high-grade CC-AVM following failed stereotactic radiosurgery. A 19-year-old female with an anterior CC-AVM presented with seizures despite being on triple anti-epileptics. The patient had previously undergone conservative management for an intraventricular hemorrhage and stereotactic radiosurgery for the AVM. Pre-operative imaging revealed a 5 cm CC-AVM located at the genu and rostrum of the corpus callosum with intraventricular extension into the third ventricle. The AVM was classified as grade 4 according to the Spetzler-Martin grading system and grade 6 according to the supplementary grading system. The lesion was exposed through the anterior interhemispheric trans-callosal approach, and microsurgical nidal dissection was performed. The large draining vein was identified, coagulated, disconnected, and resected along with the nidus. The total operative time was 12.5 h. Postoperatively, the patient had no neurological deficits and was discharged on day 10. Complete resection was confirmed on postoperative magnetic resonance imaging, and the patient remained seizure-free at the 18-month follow-up visit. This case report demonstrates the feasibility of complete surgical resection for high-grade CC-AVMs that have failed non-surgical therapy. Careful surgical planning and technique can lead to favorable outcomes in these challenging cases.
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