neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2022-24-4-85-94neurosurgery-1292Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEХирургическое лечение сочетания дуральной артериовенозной фистулы и ангиографически скрытой артериовенозной мальформации, осложнившейся внутримозговым кровоизлияниемCase report: Surgical treatment of combined dural arteriovenous fistula and angiographically occult arteriovenous malformation complicated by intracerebral hemorrhagehttps://orcid.org/0000-0003-2444-8136ПриродовА. В.PrirodovA. V.

129090 Москва, Большая Сухаревская пл., 3

117997 Москва, ул. Островитянова, 1

3 Bolshaya Sukharevskaya Sq., Moscow 129090

1 Ostrovitianov St., Moscow 117997

https://orcid.org/0000-0003-1525-1585БахаревЕ. Ю.BakharevE. Yu.

Евгений Юрьевич Бахарев

129090 Москва, Большая Сухаревская пл., 3

Evgeniy Yurevich Bakharev

3 Bolshaya Sukharevskaya Sq., Moscow 129090

ads_nvkz@mail.ruhttps://orcid.org/0000-0002-3685-2278КозловаР. М.KozlovaR. M.

129090 Москва, Большая Сухаревская пл., 3

3 Bolshaya Sukharevskaya Sq., Moscow 129090

https://orcid.org/0000-0001-5026-0060СинкинМ. Ю.SinkinM. Yu.

129090 Москва, Большая Сухаревская пл., 3

117997 Москва, ул. Островитянова, 1

3 Bolshaya Sukharevskaya Sq., Moscow 129090

1 Ostrovitianov St., Moscow 117997

https://orcid.org/0000-0003-3515-8329ГриньА. А.GrinA. A.

129090 Москва, Большая Сухаревская пл., 3

117997 Москва, ул. Островитянова, 1

3 Bolshaya Sukharevskaya Sq., Moscow 129090

1 Ostrovitianov St., Moscow 117997

ГБУЗ «Научно-исследовательский институт скорой помощи им. Н. В. Склифосовского Департамента здравоохранения г. Москвы»; ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава РоссииРоссияN. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department; Pirogov Russian National Research Medical University (Pirogov Medical University)Russian FederationГБУЗ «Научно-исследовательский институт скорой помощи им. Н. В. Склифосовского Департамента здравоохранения г. Москвы»РоссияN. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare DepartmentRussian Federation2022271220222448594Copyright © Природов А.В., Бахарев Е.Ю., Козлова Р.М., Синкин М.Ю., Гринь А.А., 20222022Природов А.В., Бахарев Е.Ю., Козлова Р.М., Синкин М.Ю., Гринь А.А.Prirodov A.V., Bakharev E.Y., Kozlova R.M., Sinkin M.Y., Grin A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1292Введение

Введение. Церебральные артериовенозные мальформации и дуральные артериовенозные фистулы – относительно редкая патология c частотой встречаемости 1–1,5 и 0,1–0,2 случаев на 100 тыс. населения в год соответственно. Вероятность сочетания данной патологии у одного пациента крайне низка. В литературе авторам не удалось найти публикации, посвященные сочетанию данной патологии сосудов головного мозга.

Цель работы – представить клинический случай успешного хирургического лечения сочетанной церебральной патологии: дуральной артериовенозной фистулы и ангиографически скрытой артериовенозной мальформации у пациента с внутричерепным кровоизлиянием.

Материалы и методы

Материалы и методы. Проведен анализ результатов лечения пациента с дуральной артериовенозной фистулой с геморрагическим типом течения в ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского» ДЗМ (Москва). Пациенту выполнена костно‑пластическая трепанация черепа, иссечение дуральной артериовенозной фистулы. Интраоперационно выявлена ангиографически скрытая артериовенозная мальформация, которая послужила причиной кровоизлияния.

Результаты

Результаты. Проведенное хирургическое лечение позволило достичь удовлетворительного исхода. Выявленная интраоперационно, ангиографически скрытая артериовенозная мальформация подтверждена гистологически.

Заключение

Заключение. Представленное клиническое наблюдение иллюстрирует необходимость тщательной ревизии полости гематомы при наличии изолированного паренхиматозного кровоизлияния из дуральной артериовенозной фистулы.

Background

Background. Cerebral arteriovenous malformations and dural arteriovenous fistulas are relatively rare pathologies with frequency of 1–1.5 and 0.1–0.2 cases per 100 000 people per year, respectively. Probability of a combination of these pathologies in a single patient is extremely low. The authors were not able to find publications describing a combination of these pathologies of the cerebral vasculature.

Aim

Aim. To present a clinical case of successful surgical treatment of combined cerebral pathology – dural arteriovenous fistula and angiographically occult arteriovenous malformation – in a patient with intracranial hemorrhage.

Materials and methods

Materials and methods. Analysis of the results of treatment of patient with dural arteriovenous fistula with hemorrhagic disease course at the N.V. Sklifosovsky Research Institute of Emergency Medicine (Moscow) was performed. The patient underwent osteoplastic cranial trepanation, resection of the dural arteriovenous fistula. Intraoperatively an angiographically occult arteriovenous malformation was detected which caused the hemorrhage.

Results

Results. Surgical treatment allowed to achieve a satisfactory outcome. Intraoperatively diagnosed angiographically occult arteriovenous malformation was confirmed histologically.

Conclusions

Conclusions. The presented clinical observation shows the necessity of careful revision of hematoma cavity in the presence of isolated intraparenchymal hemorrhage from dural arteriovenous fistula.

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The authors declare that there are no conflicts of interest present.