塞栓術にて完治せしめた成人pial AVFの1例

Endovascular Treatment of Adult Pial Arteriovenous Fistula

Ⅰ．はじめに

　Pial arteriovenous fistula（以下，PAVF）は，稀な脳血管疾患である^4,13)．以前はarteriovenous malformation（AVM）の一亜型と考えられていたが，最近になってAVMとは異なる病態として考えられるようになり，注目を集めている⁵⁾．形態学的には，動脈が静脈に直接短絡し，介在するnidusを持たない点でAVMと異なり，数少ない過去の報告では，出血例の自然経過は予後不良とされている⁸⁾．また過去の報告の多くは小児例であり，成人例は非常に稀である^5,11)．

　今回われわれは，出血発症した成人PAVFに対し，液体塞栓物質N-butyl eyanoacrylate（NBCA）による血管内治療により完全閉塞し得た1例を経験したので，文献的考察を加え，報告する．

　The authors report a case of adult pial arteriovenous fistula successfully treated by endovascular glue embolization. A 65-year-old man presented with left hemiparesis and was admitted to the local hospital. Computed tomography scan showed a cerebral hematoma. Cerebral angiography revealed pial single-channel arteriovenous fistula at the right angular artery. An emergent craniotomy was performed and hematoma was successfully evacuated on the next day. Since the post-operative angiography revealed a persisting arteriovenous fistula, the patient was referred to our institute for additional treatment. With the patient under local anesthesia, endovascular treatment was performed through the trans-femoral artery approach. A flow-guided microcatheter was successfully navigated just proximal to the fistula site. Histoacryl was then injected, and complete obliteration of the fistula was obtained. The subsequent course was uneventful and the patient returned to his daily life with only very mild left hemiparesis. Endovascular glue embolization plays an important role in the treatment of pial arteriovenous fistula.