両側性頭頂・後頭脳動静脈奇形の1例

BILATERAL ARTERIOVENOUS MALFORMATION OF THE CEREBRAL VESSELS IN THE PARIETOOCCIPITAL REGION: CASE REPORT

はじめに

　Perret＆Nishioka^1）は1966年453例のarteriovenousmalformation （AVM）について総括的な報告を行なつた。このなかに9例の両側性AVMが含まれているが，頭頂・後頭部のものは1例のみ記載されている。

　私たちも両側性の頭頂・後頭部AVMを経験した。この症例では左側は中大脳動脈の頭頂・後頭部への分枝を流入動脈とする定型的なAVMであつたが，右側は前および中大脳動脈を流入動脈とするmultiplearteriovenous fistulae^2）とよぶべき形態であつた。まれな症例であると思われるので報告示る。

In the 453 cases of arteriovenous malformation (AVM) reported by Perret and Nishioka, only one case of bilateral AVM in the parietooccipital region was described. We encountered such an unique case of bilateral AVM on the surface of the cere-brum.

A 22-year-old man was admitted to Shizuoka Rosai Hospital because of headache and visual disturbance 2 weeks after the onset. The neurologi-cal examination revealed right homonymous hemi-anoptic complaint and Wernicke's aphasia accom-panied with acalculia, apraxia, and euphoria. Carotid angiogram revealed bilateral AVM situated on the surface of the parieto-occipital region. The left AVM was fed through the left middle cerebral artery, the right being fed through the right anterior and middle cerebral artery respectively.

An operation was done one month after the onset of symptoms. The left AVM, composed of feeling arteries, congeries of vessels, and dilated abnormal veins draining to superior sagittal sinus, was removed. The right appeared multiple arterio-venous fistulae, in which the feeding arteries were clipped to the extent of disappearance of surface draining red veins.

The postoperative course was uneventful, except loss of stereoscopic vision of which was complained for some months. The right follow up carotid angiogram performed 10 months following the operation, confirmed no recurrence of the fistulae.