環軸椎後方固定術後に発生した椎骨動脈動静脈瘻の1例

Vertebral Arteriovenous Fistula as a Complication of Atlantoaxial Transarticular Screw Fixation―Case Report

はじめに

　椎骨動脈動静脈瘻は刺創や銃創などの外傷，中心静脈穿刺，頸椎手術などの合併症として稀にみられる病態^1－3）であるが，頸椎環軸椎後方固定術後に発生することは非常に稀である。今回われわれは，若年性関節リウマチによる環軸椎亜脱臼に対する環軸椎後方固定術後に発生した右椎骨動脈動静脈瘻に対し，血管内手術を行い良好な結果を得た1例を経験したので，若干の文献的考察を加え報告する。

Abstract

　We report a rare case of a vertebral arteriovenous fistula that developed as a complication of atlantoaxial transarticular screw fixation.　The patient was a 44-year-old male with a history of juvenile rheumatoid arthritis.　He had undergone an atlantoaxial transarticular screw fixation for an atlantoaxial dislocation.　At 2 months after the surgery, he complained of right-side tinnitus.　A selective left vertebral angiography showed a high-flow arteriovenous fistula of the right V2 segment and occulusion of the right vertebral artery at the level of the C3 vertebral body.　Endovascular embolization of the arteriovenous fistula was successfully performed using detachable coils.　No deficits were observed after the treatment, and the tinnitus disappeared completely.　Endovascular coil embolization is currently an effective and safe treatment for the vertebral arteriovenous fistula.