海綿静脈洞部硬膜動静脈奇形治療時の症状悪化と経時的血管写所見の比較検討

Correlation between Sequential Change of Angiographical Findings and Clinical Deteriorations During Management for Dural AVM of the Cavernous Region

　海綿静脈洞部硬膜動静脈奇形の初期治療として5例に徒手的頸部圧迫法を行い，その経過中に高眼圧症状の悪化を4例に認めた。悪化4例の臨床経過と経時的血管写所見の変化から，悪化原因について検討した。悪化例は徒手的頸部圧迫施行後，11-20日間で高眼圧症状の著明な悪化を示した。悪化時脳血管写所見で流入動脈の増加例はなく，流出路の減少を3例に認めたことから，流出路減少が悪化原因と考えた。さらに，その後5例中4例が症状の著明改善ないし寛解を示した。寛解時脳血管写所見では流入動脈の消失例を1例に認め，2例はシャント量に変化を認めず，顔面静脈を介する流出路の発達を認めた。したがって，症状の寛解にシャント量の減少のほか，流出路の発達が関与した可能性が示唆された。

The authors treated five patients with dural arter-iovenous malformation of the cavernous region (DAVM) by cervical compression procedure as the initial treatment. In four of five patients clinical symp-toms were aggravated during that period. The period between the beginning of cervical compression and the deterioration of clinical symptoms ranged from 11 to 20 days. In three of four patients, the angiography examined at the time of deteriorations confirmed the same amount of A-V shunt flow and otherwise the remarkable decrease of the draining pathway compared to the findings of the angiogram performed before the management.

The angiography examined at the time of the remis-sion of the symptoms showed the increase of the drain-ing pathway in two patients and the resolution of the DAVM in another. These findings indicate that clinical courses of the DAVM and the amount of the draining pathway correlate to each other and that cervical com-pression procedure may occlude the important draining pathway of the DAVM.