外傷性中硬膜動静脈瘻の1例

TRAUMATIC ARTERIO-VENOUS FISTULA OF THE MIDDLE MENINGEAL ARTERY

I．はじめに

　硬膜外血腫は頭部外傷後中硬膜動脈の損傷によつて生じることは周知のことである。急性期に脳血管撮影を行なつて，中硬膜動脈の損傷を造影剤の血管外漏出や中硬膜動脈の偽動脈瘤形成によつて直接証明した報告はあるが，外傷によつて中硬膜動脈が損傷され，その随伴静脈や板間静脈との間に動静脈瘻が形成され，それが脳血管撮影によつて証明された症例に関する報告は，きわめて稀である。私共は，硬膜外血腫患者に中硬膜動脈とその随伴静脈との間に動静脈瘻を形成した症例を脳血管撮影によつて証明したので報告する。

(1) This is a report of a case of the traumaticarteriovenous fistula of the middle meningeal artery, complicated by epidural hematoma. The patient was a 37 year-old male, who had suffered from head in-jury with a resulting slight right side hemiparesis and gradual exacerbation of level of consciousness after short lucid interval.

The arterio-venous fistula between the middle meningeal artery and the accompanying veins drain-ing into the superior sagittal sinus was demonstrated by carotid angiography, together with radiological evidence of an epidural hematoma. There was an uneventful recovery after the removal of the hema-toma, and electrocoagulation of the middle mening-eal vessels.

(2) The reports on the traumatic arterio-venous fistulas of the middle meningeal artery are very rare in the literature and only two cases could be found in Japan.

(3) The reported case on the traumatic middle meningeal arterio-venous fistulas and the mechanism of its occurrence were discussed.

(4) The common carotid angiography should he performed in the patient with head injury to dis-close the radiological findings both of the external and internal tributaries.