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Brain and Nerve No to Shinkei Volume 42, Issue 10 （October 1990）

Brain and Nerve 脳と神経 42巻10号（1990年10月発行）

Japanese English

原著

小脳の動静脈奇形—自験14例の検討 CEREBELLAR AVM:CLINICAL ANALYSIS OF 14 CASES 安藤隆 ¹ , 坂井昇 ¹ , 山田弘 ¹ , 荒木有三 ¹ , 今尾幸則 ¹ , 出口一樹 ¹ , 西村康明 ¹ , 船越孝 ² , 高田光昭 ³ Takasi Andoh ¹ , Noboru Sakai ¹ , Hiromu Yamada ¹ , Yuhzoh Araki ¹ , Yukinori Imao ¹ , Kazuki Deguchi ¹ , Yasuaki Nishimura ¹ , Takashi Funakoshi ² , Mituaki Takada ³ ¹岐阜大学医学部脳神経外科 ²総合大雄会病院脳神経外科 ³高山赤十字病院脳神経外科 ¹Department of Neurosurgery, Gifu University School of Medicine ²Department of Neurosursery, Daiyukai General Hospital ³Department of Neurosurgery, Takayama Red Cross Hospital キーワード： arteriovenous malformation , cerebellum Keyword: arteriovenous malformation , cerebellum pp.913-921

発行日 1990年10月1日 Published Date 1990/10/1

DOI https://doi.org/10.11477/mf.1406900104

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Abstract 文献概要
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　小脳のAVM 14例について臨床症候・経過および治療上の問題点について検討した。発生頻度は全AVMのうちの7.5％を占めた。臨床症候としては出血発症が12例（86％）と多く頭痛，神経症候は各々1例ずつでsteal現象によると思われた。小脳内出血によりriskが悪かった4例中3例を救命し得ており，hopelessにみえても積極的に血腫除去とAVM摘出を行うべきである。手術手技上，問題はAVMが小脳上面もしくは脳幹に近接して存在する場合である。自験例は，全例，腹臥位による後頭下開頭にて摘出でき，予後も良好であった。脳幹に近接する場合，術前のMRIは有用な情報を与えてくれる。保存療法の1例は再出血で死亡しており，小脳のAVMは手術自体による悪化例がみられなかったことからも積極的手術が望ましい。特殊例として流入動脈上に脳動脈瘤の合併がみられた2例，ならびに生後7日目の新生児例で，小脳扁桃のsmall AVMの1例についても報告する。

The authors report on their experience with 14 cases of cerebellar arteriovenous malformation (AVM), with emphasis on their clinical symptoms and treatment problems. The incidence of cere-bellar AVM was 7. 5% in all cases of intracranial AVM. Twelve of them pre ented with hemor-rhages, one with a headache and one with a focal neurological dificit related to the "steal" phenom-enon.

Three out of 4 poor risk patients with intracere-bellar hematoma recovered well after their oper-ations. Thus, we can say that surgical treatment should be performed even if the patient's state seems hopeless.

The nidus was located at the vermis in 7, at the cerebellar hemisphere in 5, and at the tonsil in 2 cases. The surgical approach to the superiorsurface of cerebellum or the tonsil near the brain-stem became a problem.

In our series, all surgically treated cases were approached through the suboccipital route with the patient in the prone position and the surgical results were favorable. On the other hand, one case which underwent conservative treatment died due to rebleeding. Thus, as the follow-up mor-tality with conservative treatment is higher and the results of surgery are better, surgical treatment should be attempted.

Preoperative MR imaging is one of the useful methods used to determine whether an excision is possible without significant deficit, especially in cases in which the AVM is located near the brain stem.

In our series, two patients had concomitant aneu-rysms related to feeding arteries. Another inter-esting case of a neonate who had a small tonsillar AVM is reported.