PATHOLOGICAL HETEROGENEITY OF ANGIOGRAPHICALLY OCCULT VASCULAR MALFORMATIONS OF THE BRAIN
PATHOLOGICAL HETEROGENEITY OF ANGIOGRAPHICALLY OCCULT VASCULAR MALFORMATIONS OF THE BRAIN
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DOI：
10.1227/00006123-199310000-00001
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发表时间：
1993-10-01
期刊：
影响因子：
4.8
通讯作者：
ESTES, ML
中科院分区：
文献类型：
--
作者：
ROBINSON, JR;AWAD, IA;ESTES, ML
关于大脑血管造影隐匿性血管畸形（AOVM）的病理基础及其临床意义，文献中存在相当大的混乱。我们回顾性分析了 10 年来在同一机构连续 34 例 AOVM 患者接受手术切除的病例。重新检查病理标本，并根据严格的组织病理学标准对病变进行分类。海绵状血管畸形 21 例，动静脉畸形 3 例，静脉畸形 3 例，毛细血管畸形 2 例，混合性（病理异质性）病变 5 例。 34 例中的 18 例 (53%) 最初的病理诊断报告不精确或错误识别了病变类型，最常见的是将海绵状血管瘤标记为动静脉畸形或未识别同一病变内的混合特征。不同病变类型的临床表现（包括出血）和结果没有显着差异。术前诊断成像包括在研究期间引入或发展的各种方式，通常提示可疑血管畸形，但不能预测病理亚型。该手术系列中的急性血肿使得潜在血管畸形的识别具有高度推测性。我们的结论是，大多数需要手术干预的 AOVM 是海绵状血管畸形，尽管其余病变存在显着的病理异质性。 AOVM 的组织病理学亚型与独特的临床或放射学特征无关。
THERE IS CONSIDERABLE confusion in the literature regarding the pathological substrates of angiographically occult vascular malformations (AOVMs) of the brain and their clinical significance. We retrospectively reviewed the cases of 34 consecutive patients with AOVMs undergoing surgical excision at a single institution during a 10-year period. Pathological specimens were reexamined, and the lesions were classified according to strict histopathological criteria. There were 21 cavernous malformations, 3 arteriovenous malformations, 3 venous malformations, 2 capillary malformations, and 5 mixed (pathologically heterogeneous) lesions. The initial pathological diagnostic report had been imprecise or had misidentified the lesion type in 18 of the 34 cases (53%), most commonly labeling a cavernous malformation as an arteriovenous malformation or not recognizing mixed features within the same lesion. Clinical presentation (including hemorrhage) and outcome were not significantly different among the various lesion types. Preoperative diagnostic imaging included a variety of modalities that were introduced or evolved during the period of the study and generally suggested a suspected vascular malformation but did not predict pathological subtypes. Acute hematomas in this surgical series made the identification of underlying vascular malformations highly speculative. We conclude that the majority of AOVMs requiring surgical intervention are cavernous malformations, although there was a notable pathological heterogeneity of the remaining lesions. Histopathological subtypes of AOVMs are not associated with unique clinical or radiographic features.