後頭動脈塞栓後に胸鎖乳突筋の虚血を来した横・S状静脈洞部硬膜動静脈瘻の1症例

Ischemia of the Sternocleidomastoid Muscle following Occipital Artery Embolization for Dural Arteriovenous Fistula

Ⅰ．はじめに

　外頸動脈系の塞栓術は，髄膜腫などの腫瘍摘出術前や頭蓋内硬膜動静脈瘻（dural arteniovenous fistula : dAVF）に対して広く行われている．外頸動脈は側副血行路が豊富であるため，経動脈的塞栓術（transcatheteric hepatic arterial embolization : TAE）後に頭頸部の筋組織の梗塞を来すことは稀である．しかし今回，fiber platinum coil（FPC）とpolyvinyl alcohol （PVA）による後頭動脈（OA）のTAE後に臨床症状とMRI所見から胸鎖乳突筋の虚血と考えられたdAVFの1症例を経験した．このような合併症報告は稀であり，後頭動脈の塞栓術に際し知っておくべきものと考えられたので報告する．

We report a case of localized ischemia of the sternocleidomastoid muscle (SCM) occurring after occipital artery embolization of a dural arteriovenous fistula (dAVF).

　A 45-year-old man presented intracerebral hemorrhage from a dAVF at the left transverse-sigmoid sinus. The dAVF had a high flow fistula from the left occipital artery (OA). Endovascular therapy was carried out one month later. Transarterial embolization of the OA was carried out prior to the transvenous approach to decrease the shunt flow. During obliteration of the proximal portion of the OA with fiber platinum coils and polyvinyl alcohol particles, the patient reported severe neck pain. The fistula was successfully embolized after transvenous packing of the left sigmoid sinus with detachable coils. The neck pain persisted for one week and disappeared after conservative treatment.

　T2-MR imaging 3 days after the embolization showed a hyperintensity in the left SCM. This ischemic lesion was probably induced by occlusion of the muscular branch of the OA. We discuss this common but rarely reported complication of OA embolization