外傷性中硬膜動静脈瘻の4例

TRAUMATIC ARTERIO-VENOUS FISTULAS OF THE MIDDLE MENINGEAL ARTERY: REPORT OF FOUR CASES

Ｉ．緒言

　中硬膜動脈領域における動静脈瘻は，これまで報告された症例がきわめて少ない。臨床的には，それ自体特異な症状を呈することが少なく，また症状によっては，頭蓋内血腫または脳挫傷などと見誤られることもあり，あるいは実際にそれらと合併して発症する例が多く，後者の症状に被われて，診断を困難にする場合が多い。われわれは最近，そのような外傷性急性頭蓋内血腫に合併した中硬膜動脈由来の動静脈瘻を4例経験したので報告し，諸家の報告例に合わせて，いささかの文献学的考察を行なってみたいと思う。

Four cases of traumatic arterio-venous fistulas of middle meningeal vessels were reported with brief review of 15 cases which had been reported pre-viously.

Twelve of 19 cases are related to intracranial hematomas.

In cases of those without intracranial hematoma, symptoms were 1) continuous, rather localized dull headache and/or 2) continuous, pulsating noise most intensive in the preauricular region.

Intracranial noise or bruit were reported in only three cases. In these cases, A-V fistulas were loca-lized at the beginning of the middle meningeal artery or near the petrosal bone, and the venous drainswere towards the petrosal portion containing the auditory organ.

In arteriogram, typical finding of the A-V fistula is visualized as "railroad-track appearance" or "tram-track appearance".

This was noted in our cases by selective external carotid angiography.