Клинический случай артериовенозной мальформации

Abstract

Arteriovenous malformation (AVM) is a congenital malformation of cerebral vessels, associated with an abnormal connection of arteries and veins. The altered locations of the cerebral vascula-ture form a conglomerate that is a direct arteriovenous shunting without intermediate capillaries. The incidence of the disease is 4 cases per 100 thousand population. Clinically, AVM debuts mainly at the age of 20 to 40, and is accompanied by intracranial hemorrhages in 50% to 60% of patients; mortality is 35%. In 27% to 70% of individuals, AVM are manifested by epileptic seizures of various focal origins. In diagnostics, X-ray computed tomography is used to detect hemorrhage in case of a ruptured malformation; magnetic resonance imaging, including angiography, to assess the AVM node, afferent vessels and venous drainage. Currently, the only radical treatment for AVM is surgical removal of the malformation. This is feasible for small and medium-sized AVMs of cerebral vessels (36% to 50% of patients), since removal of large AVMs and AVMs located in functionally important areas, even microsurgically, is associated with a high risk of death and disability. A clinical case of a 30-year-old young patient with an acute onset of the disease characterized by sudden loss of consciousness and an episode of seizures is presented. Based on the data of clinical and instrumental examination, an AVM of the left parietal lobe with parenchymal-ventricular hemorrhage was revealed. On the day of admission to the hospital in Ryazan, a surgical intervention was performed: external ventriculostomy on the left side. After 4 months the second surgical intervention, removal of AVM of the left parietal region using neurophysiological control was carried out at Burdenko Neurosurgical Hospital in Moscow, Russia. The successful surgical approach has completely eliminated the life-threatening pathology. Subsequently, the patient underwent rehabilitation in a neurological hospital at the place of residence. CONCLUSION: The topic of AVM is of great practical interest not only for neurosurgeons, but also for neurologists and radiologists, since timely diagnosis and treatment effectiveness directly depend on the coordinated work of these specialists.