脳幹梗塞で発症した頭蓋内硬膜動静脈瘻の1例

A Case of Intracranial Dural Arteriovenous Fistula presenting with Brainstem Infarction

Ⅰ．はじめに

　脳幹梗塞で発症する頭蓋内硬膜動静脈瘻は稀である．われわれは，延髄梗塞で発症した頭蓋内硬膜動静脈瘻の1例を経験し，血管内治療上の興味ある所見を認めたので報告する．

A 68-year-old female presented with the disturbance of brainstem function. Brain T2 weighted and FLAIR (fluid-attenuated inversion recovery) magnetic resonance imaging revealed the hyperintensity signal of the medulla oblongata,which led to diagnosis of brainstem infarction. Diagnostic cerebral angiography showed the dural arteriovenous fistula (DAVF) developed on the left transverse sinus (TS). Venous drainage route was consisted of retrograde leptomeningieal venous reflux of the cerebrum and spinal perimedullary vein via superior petrosal sinus. Venous hypertension of the brainstem was relieved by transvenous platinum coil selective embolization of superior petrosal sinus. The correct analysis of venous drainage pattern is essential for the curative endovascular surgery.