High-flow Periorbital Arteriovenous Malformation-A Case Report

眼眶下的動靜脈畸形－一病例報告

廖國鈞(Kuo-Chun Liao) ； 林聿山(Yu-San Lin) ； 楊振(Cheng Yang) ； 劉澄(Cheng Liu) ； 陳俊嘉(Chun-Chia Chen) ； 李彥勳(Yan-Shiun Li) ； 黃國峰(Kuo-Feng Huang)

《中華民國整形外科醫學會雜誌》 18卷4期 (2009/12) Pp. 388-394

https://doi.org/10.7096/JPSA.200912.0388

摘要

背景：
眼眶旁的動靜脈畸形罕見，相關併發症包括疼痛、潰瘍、出血與外觀心理上的影響，甚至是視力病變。利用M.R.A.或angiography診斷供應病灶的血管，是決定處置的重要步驟。
目的及目標：
治療的適應症包括大量出血、周圍重要器官組織的侵犯、感染、美觀影響及疼痛等。高流速血管畸形的供應動脈數量會逐漸增加，使症狀漸趨嚴重，有必要及早治療。
材料與方法：
我們報告一位50歲男性，住院前八年開始出現左眼眶下的逐漸增大搏動團塊，病人沒有外傷病史，血管攝影診斷為Schobinger Stage II AV malformation，供應血管主要是左頷動脈與左眼動脈。核磁共振顯示沒有重要器官的侵犯。由於病灶牽涉眼動脈，使治療策略格外審慎。病人術前接受左頷動脈眼眶支的栓塞，16小時後進行完全切除。
結果：
術後病人回復美觀，無相關併發症的產生，視力追蹤正常，在術後第二個月沒有復發的跡象。
結論：
個案報告中，治療策略使用術前栓塞供應動脈，減少nidus的血流量；在栓塞後第16小時進行完全切除。術後達成滿意的效果。

並列摘要

Background:
Arteriovenous malformations (AVMs) are congenital vascular lesions. They are latent until their expansion was triggered by hormonal changes of puberty or local trauma. The symptoms include pain, ulceration, intermittent bleeding, and obvious esthetic problems.
Aim and Objectives:
High-flow vascular malformations can expand due to the gradual recruitment of new feeding vessels. Lesions with intolerable symptoms such as pain or significant esthetic disfigurement or signs of impending complications, including enlargement or hemorrhage warrant immediate treatment because these can be signs of progression.
Materials and Methods:
We report a 50-year-old man without a history of antecedent trauma has had an arteriovenous malformation in the left lower eyelid region for eight years. Angiogram showed the AVM having two main arterial feeders (left internal maxillary artery and ophthalmic artery). The patient underwent preoperative superselective embolization. Sixteen hours later, he had total excision of the vascular lesion.
Results:
Visual function remained normal postoperatively. Two months later, there were no signs of recurrence.
Conclusion:
Total resection of the AVM following superselective embolization was curative for the patient presented in the article.

並列關鍵字

periorbital arteriovenous malformation ； high-flow vascular malformation ； superselective embolization