(Disclaimer: This article is for general use only. The following information has been processed to protect Ms. Jia’s privacy)
Abstract: The main character of this case is a 32-year-old Ms. Jia, who visited our hospital for “head and facial pain for 4 years and cerebral arteriovenous malformation for 1 week”. 1 week ago, the head MRI indicated cerebral arteriovenous malformation. The postoperative pathology was consistent with vascular malformation and the diagnosis was clear.
Basic information】Female, 32 years old
Disease Type】Arteriovenous malformation
Hospital】Liaoning Provincial People’s Hospital
Date of consultation】March 2021
Treatment plan】Surgical treatment (posterior cranial fossa craniotomy, cranial repair) + medication (compound mannitol injection, cefoperazone sodium for injection, cytarabine sodium glucose injection)
Treatment period】10 days of inpatient treatment, 1 year of outpatient follow-up
Treatment effect】Postoperative head and facial pain was significantly reduced, and no recurrence of disease was seen on MRI review
I. Initial consultation
In March 2021, Ms. Jia came to our clinic with the main complaint of “head and facial pain for 4 years and cerebral arteriovenous malformation for 1 week”. One week ago, Ms. Jia visited a local hospital and had an MRI of her head, which indicated cerebral arteriovenous malformation. Physical examination: clear consciousness, accurate replies, normal olfaction and visual acuity, 2.5mm pupils bilaterally, sensitive direct and indirect light reflexes, free eye movements in all directions, no nystagmus, sensitive corneal reflexes bilaterally, right facial pain, hyperalgesia, strong chewing and biting bilaterally, no choking and coughing when drinking, no hoarseness, no dysphagia, negative bilateral Bartholomew’s sign, muscle strength of all four limbs grade V.
II. Treatment history
After admission, the relevant biochemical tests were completed, and because Ms. Jia was relatively young, the diagnosis was clear, and no obvious contraindications to surgery were seen in the biochemical tests. Ms. Jia’s symptoms were obvious and were considered to be related to congenital arteriovenous malformation, so she was recommended to undergo surgery. After completing the relevant preoperative preparations, a craniotomy of the posterior cranial fossa for the arteriovenous malformation of the cerebellum and skull repair were performed under general anesthesia. Postoperatively, Ms. Jia was given compound mannitol injection to lower the cranial pressure, cefoperazone sodium for injection as an anti-inflammatory agent, and cytarabine sodium glucose injection to nourish the nerves and other symptomatic treatments, and her head and facial symptoms were gradually relieved. Postoperative pathological return: consistent with vascular malformation changes, the diagnosis is clear. After the operation, regular drug changes were given to the head incision. Vital signs were stable during the perioperative period, and no obvious neurological symptoms and signs were seen. 10 days later, Ms. Jia’s head and facial pain symptoms were significantly relieved, and the incision healed well, and she was discharged successfully.
(Postoperative pathology)
III. Treatment effect
Ms. Jia’s postoperative effect was obvious, and the lesion was completely removed and sent to pathology. Postoperatively, Ms. Jia’s head and facial pain symptoms were gradually relieved, her perioperative vital signs were stable, and there were no clear neurological complications. Postoperative pathological return: consistent with vascular malformation changes. Ten days after surgery, Ms. Jia’s head and facial pain was significantly relieved and she was almost asymptomatic. The head MRI was repeated and the results returned: postoperative changes in the cranium and no obvious vascular malformation was seen. Six months and one year after surgery, the incision was completely healed with no obvious complaints of discomfort, and no recurrence of arteriovenous vascular malformation was seen by head MRI.
IV. Notes
We are glad that after surgical treatment, Ms. Jia’s cerebral arteriovenous malformation was successfully removed and her headache symptoms were significantly relieved, and no recurrence occurred during the follow-up period. Most arteriovenous malformations are congenital, and there is a risk of recurrence even after surgical removal. It is important to pay attention to regular review after surgery, and seek medical attention promptly if dizziness, vomiting, impaired consciousness, hemiparesis, or aphasia occur. If symptoms such as dizziness and headache can occur after surgery, pay more attention to rest, avoid prolonged mental or physical labor, ensure sleep time and sleep quality, and pay attention to diet to avoid spicy and stimulating foods, eat more high-quality protein and avoid over-eating.
V. Personal insight
Arteriovenous malformations, mostly congenital, are the most common cause of intracranial hemorrhage other than intracranial aneurysm, and surgery is the only method of treatment. With the development of interventional devices, minimally invasive interventions are also a means of treatment for arteriovenous malformations, but the indications for surgery need to be strictly controlled. Patients with arteriovenous malformations vary from person to person, and the choice of the surgical approach and the development of the surgical plan are based on a detailed assessment of the preoperative examination, which has to be carefully grasped by a specialized doctor. Regular postoperative review is also needed to avoid recurrence of the vascular malformation. Through this case, we are warned not to be careless if head and facial discomfort occurs, but to seek immediate medical attention for clear diagnosis, early detection and early treatment.