巨大動脈瘤様陰影からの破裂を伴った幼児脳動静脈奇形の救急手術治験例

概要

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The authors reported a case of an arteriovenous malformation (AVM) which showed a giant aneurysmal dilatation and caused an intracerebral hemorrhage in a 3-year-old girl. The patient suffered from severe headache and vomiting after a Jacksonian convulsion. On admission 25 hours from the onset, she was delirious and showed motor weakness of the right extremities. The CT scan on admission demonstrated a ring-like high density area surrounding an isodense area which was markedly enhanced by the contrast medium. Carotid angiography demonstrated the nidus of an AVM with a giant aneurysm 4.0 cm in diameter, fed via the A_2 portion of the left anterior cerebral artery (ACA). The operation performed immediately was very difficult because of massive bleeding from the ruptured giant aneurysm. The hemorrhage was controlled by temporary occlusion of the left ACA under the intravenous administration of 20% mannitol; the feeding artery was therefore safely occluded for 32 minutes under normal body temparature. The nidus with the giant aneurysm was totally removed and no neurological deficit remained postoperatively. The child is now leading a normal school life. Histology of the serial sections of the nidus showed that the aneurysmal portion was an extensively dilated vascular component which consisted of a mixture of arterial and venous structures.
日本脳神経外科学会の論文
1983-08-15