Clinical implications of associated venous drainage in patients with cavernous malformation
Clinical implications of associated venous drainage in patients with cavernous malformation
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DOI：
10.3171/jns.2005.102.1.0024
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发表时间：
2005-01-01
影响因子：
4.1
通讯作者：
Kuratsu, JI
中科院分区：
文献类型：
--
作者：
Kamezawa, T;Hamada, JI;Kuratsu, JI
Object.作者回顾了海绵状血管畸形患者的血管造影片，以识别和表征并存的静脉引流。1994年至2002年期间在作者所在机构治疗的57例海绵状血管畸形患者根据血管造影研究中畸形附近的静脉系统分为三组。A组患者（23例患者）的畸形没有静脉引流; B组患者（14例患者）的病变与典型的静脉畸形相关; C组患者（20例患者）的病变有非典型静脉引流（AVD）。根据相关静脉引流的类型分析出血的风险，并确定磁共振（MR）成像与数字减影（DS）血管造影在显示相关AVD方面的有效性。57例患者有67个海绵状畸形：A组患者有29个海绵状畸形，无相关静脉引流，B组患者有17个病变，与静脉畸形相关。C组共21个病灶，其中20个表现为AVD。A组23例患者中有10例（43.5%）出现症状性出血，B和C组34例患者中有28例（82.4%）出现症状性出血。尽管高分辨率MR成像显示14例B组患者中有11例（78.6%）存在相关静脉畸形，但此类研究显示20例C组患者中仅2例（10%）存在AVD。海绵状血管畸形合并静脉畸形或AVD的患者比单纯海绵状血管畸形的患者更可能出现症状性出血。当单独使用MR成像而不是结合DS血管造影时，可能会低估相关静脉引流的实际发生率。
Object. The authors reviewed angiograms obtained in patients with cavernous malformations to identify and characterize coexisting venous drainage.Methods. Fifty-seven patients with cavernous malformations treated at the authors' institutions between 1994 and 2002 were classified into three groups according to the venous system adjacent to the malformation on angiography studies. In Group A patients (23 patients) the malformations had no venous drainage; in Group B patients (14 patients) the lesions were associated with typical venous malformations; and in Group C patients (20 patients) the lesions had atypical venous drainage (AVD). The risk of hemorrhage based on the type of associated venous drainage was analyzed, and the usefulness of magnetic resonance (MR) imaging compared with digital subtraction (DS) angiography in demonstrating associated AVD was determined.Fifty-seven patients harbored 67 cavernous malformations: Group A patients had 29 cavernous malformations with no associated venous drainage; Group B patients had 17 lesions associated with venous malformations; and Group C patients harbored 21 lesions, 20 of which manifested AVD. Symptomatic hemorrhage was present in 10 (43.5%) of 23 Group A patients and in 28 (82.4%) of 34 Groups B and C patients. Although high-resolution MR imaging revealed the presence of associated venous malformations in 11 (78.6%) of 14 Group B patients, such studies demonstrated AVD in only two (10%) of 20 Group C patients.Conclusions. Patients harboring cavernous malformations plus venous malformations or AVD are more likely to present with symptomatic hemorrhage than are patients with cavernous malformation alone. The actual incidence of associated venous drainage may be underestimated when MR imaging alone is used rather than combined with DS angiography.