脳動静脈奇型の治療法の検討

INVESTIGATION OF TREATMENT FOR ARTERIOVENOUS MALFORMATION

はじめに

　頭蓋内に発生する外科的治療を要する血管性病変には脳動静脈奇型（以下AVMと略す），脳動脈瘤，外傷性動静脈腰，血管腫等がある。我々が近年2年間に経験した9例の頭蓋内AVMを中心にその治療法について検討したいと思う。AVMの治療法は脳神経外科の発達に伴つて放射線療法，減圧術，摘出術，人工栓塞術等が試みられてきた。AVMの治療は，全摘出が最善であるのは当然であるが，いかに安全に手術が施行され，またいかに術後脱落症状を少くするかという点に，我々の努力が向けられて来た。

We reported 3 cases of the rare mid-line arterio-venous malformation (AVM) out of 9 cases which we had experienced in the past two years.

The first case was a 39 year-old man with AVM of the rostral part of the vermis extended into both cerebellar hemispheres caused with a fit of subara-chnoid hemorrhage. Direct attack and total removal of AVM was performed in success.

The second case was a 33 year-old man suffered from a frequent fit of subarachinoid hemorrhage. Then AVM extended all over the vermis was proved. Direct attack was performed but total removal couldn't be done. Eight days after an operation, he had hematoma of the l-temporooccipital region and died associating with hematemesis, bloody stool and pneumonia.

The third case was a 30 year-old woman with AVM of splenium part caused by a epileptic fit. Clipping feeder, vascular net of AVM was occluded with bipolar coagulator.

We believe that there is no better treatment of AVM than its total removal, if possible. To make the post operative defect minimum, we had tried to remove only AVM by microsurgical technique since 1966 and to protect the surrounding normal brain. We have reviewed the literature and discus-sed about its cases, diagnosis, indication, approach, technical problems.