Giant dural supratentorial arteriovenous malformation.
Giant dural supratentorial arteriovenous malformation.
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巨大硬脑膜幕上动静脉畸形。
DOI：
10.2214/ajr.129.4.734
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发表时间：
1977
期刊：
影响因子：
--
通讯作者：
L. Chameides
中科院分区：
文献类型：
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作者：
I. Gordon;B. L. Shah;D. Hardman;L. Chameides
这名3，700 g男婴是一次无并发症妊娠的产物，出生于一名23岁的母亲，妊娠2次，分娩1次。Apgar scone在1 mm处为9，在5 mm处为10。在36 hn时，婴儿出现呼吸困难。检查显示中度肋间回缩，平均每毫米80次，脉率每毫米150次，外周脉搏量正常。头围为38.5 cm，触角<$房饱满，尺寸为4 x 4 cm，后<$房为4 x 3 cm。冠状缝和矢状缝被展开，并且腭骨和额骨被分开1cm。头部静脉在额部和全脑区域突出，并且在两侧的颞部和枕部区域听到连续的杂音。头骨没有透视。心内膜增厚，在胸骨左上缘听到III/VI级收缩期喷射性杂音。第二心音正常。肝缘在夜肋缘下3 cm，脾尖可触及。颅骨的内凹（图1）显示广泛分离的缝线和颅内钙化。胸片显示全身性念珠菌增大和肺血管增多。心电图显示电轴正常，并有双心室肥厚的证据。血细胞计数为46%;白色血细胞计数为12，700;血小板计数为28，000。在对充血性心力衰竭进行洋地黄和利尿剂治疗后，进行了双侧颈动脉血管造影（图2），显示了由显著扩张的颈外动脉供血的巨大静脉囊。椎动脉极度迂曲，无法插入导管。由于心血管状况恶化，结扎了双侧颈外动脉，试图控制患者的充血性心力衰竭。在初步改善后，婴儿出现心输出量减少，无法控制的酸中毒，尽管采取了所有措施支持他，但在手术后48小时死亡。尸检时，在纵裂沙丘内发现一个7厘米的囊状空腔。没有脑积水的证据。直窦和窦口位置较低，后颅窝因巨大的沙丘动静脉畸形而较小。由于脑膜中血管流量大，双侧棘孔明显增大。讨论
This 3,700 g male infant was the product of an uncomplicated pregnancy, born to a 23-year-old, gravida 2, pama 1 mother. Apgar scone was 9 at 1 mm and 10 at 5 mm. At age 36 hn, the infant was noted to have respiratory difficulty. Examination mevealed moderate intercostalretractionswith a respiratorymateof 80/mm. Pulse rate was 150/mm, and peripheral pulses were normal in volume. Head circumference was 38.5 cm, the antenon fontanelle was full and measured 4 x 4 cm, and the postenor fontanelle was 4 x 3 cm. Coronal and sagittal sutures were spread, and the pamietal and frontal bones were separated by 1 cm. Scalp veins were prominent over the frontal and panietal regions, and a continuous bruit was heard over the temporal and occipital areas bilaterally. There was no transillumination of the skull. The pmecondium was hypendynamic, and a grade Ill/VI systolic ejection murmur was heard over the left upper sternal border. The second heart sound was normal. The liver edge was 3 cm below the night costal margin, and the spleen tip was palpable. Skull nadiognaphs (fig. 1) showed widely separated sutures and intracranial calcifications. Chest films revealed generalized candiomegaly and increased pulmonary vasculatune. The electrocandiogmam showed a normal axis and evidence of biventniculam hypertnophy. Hematocnit was 46%; white blood cell count, 12,700; and platelet count, 28,000. After digitalis and diuretic therapy for congestive heart failume, a bilateral carotid angiogram was performed (fig. 2) which showed a huge dunal venous sac fed by markedly dilated extennal carotid arteries. The vertebral arteries could not be catheterized because of extreme tortuosity. Because of a deteriorating cardiovascular status, both extennal carotid arteries were ligated in an attempt to control the patient’s congestive heart failure. After initial improvement, the infant developed a decrease in cardiac output, uncontrollable acidosis, and, despite all measures to support him, expired 48 hr after surgery. At postmortem examination, a 7 cm saclike cavity was found within the interhemisphenic duna. There was no evidence of hydrocephalus. The straight sinus and torcula were low in position, and the posterior fossa was small due to the large dunal arteniovenous malformation. The fomamen spinosum was markedly enlarged bilaterally due to the large flow through the middIe meningeal vessels. Discussion