外傷性脳動静脈瘻

ARTERIOVENOUS FISTULA OF THE CORTICAL VESSEL CAUSED BY CLOSED HEAD INJURY CASE REPORT

緒言

　外傷性頭蓋内動静脈瘻として，内頸動脈海綿状静脈洞瘻，中硬膜動静脈瘻，外頸動脈頭蓋内静脈洞瘻などが経験される。しかし代表的な報告を検討しても，外傷によつて生じた脳皮質血管（cortical vessel）の動静脈瘻は記載されていない^1）〜4）。

　私たちは閉鎖性頭部外傷の1症例に，callosomarginalarteryとそれに接する静脈間の動静脈瘻を発見した。臨床像や手術所見などから頭部外傷によつて形成されたものとみなされたので報告する。

Traumatic arteriovenous fistula of the cortical vessel has rarely been documented. We encounter-ed such an unique case of the fistula between the left callosomarginal artery and the adjacent vein apparently caused by closed head injury.

A 23-year-old man admitted to Shizuoka Rosai Hospital shortly after head injury. The neurologi-cal examination revealed no abnormalities except for confused state. There was no definite history of cerebrovascular disease. Skull X-rays verified no fracture. Left carotid angiogram taken 6 days after admission disclosed the unusual AV fistula above mentioned. A left frontal craniotomy was done on 28th hospital day. There was no pia-arachnoid thickening over the dorsal surface of the left frontal lobe. The AV fistula and the surround-ing fibrous adhesion was found in close proximity to the edge of falx cerebri. In order to avoid the arterial occlusion, a Scoville clip was applied to the fistulous portion of the draining vein, parallel to the feeding callosomarginal artery.

The patient did well postoperatively and the follow up angiogram performed 10 months later showed no recurrence of the AV fistula.

Judging from the clinical picture and the opera-tive finding, it was likely that the callosomarginal artery and the adjacent vein was traumatized by the edge of falx and the fistula was formed during head injury.