Arteriovenous malformation of the tongueの1例―血管解剖と経動脈的塞栓術の留意点

A Case Report of Arteriovenous Malformation of the Tongue: Vascular Anatomy and Note for Transarterial Embolization

Ⅰ．はじめに

　舌は頭頸部血管性病変の発生部位としては比較的稀な場所である．頭頸部血管性病変は血管腫と血管奇形に大別され，またその中でも細分化されているが，しばしばその鑑別は難しい³⁾．血管奇形の治療方法には経動脈的または直接穿刺による塞栓術，摘出術，放射線治療，レーザー治療などさまざまな方法が報告され，適切な診断・治療選択に苦慮することもある⁷⁾．安易な塞栓術はその後の治療経過を悪化させることもあるので，舌周囲の血管解剖や塞栓術の留意点を熟知する必要がある．われわれは塞栓術と摘出術で治療した舌動静脈奇形を経験し，主に塞栓術の留意点を考察した．

　Arteriovenous malformation (AVM) of the tongue is a rare lesion of the cranio-facial vascular anomaly. Decision making concerning the vascular anomaly is not established because there are complex classifications of diagnosis and many treatment options.

　We report a case of AVM of the tongue, and review vascular anatomy and knowledge for treating this lesion.

　A 50-year-old man presented with dysarthria, sleep apnea and snoring because of a mass lesion of his sublingual region that had become larger over a two-year period. Neuroradiological examination revealed lingual arteriovenous fistula (AVF) associated with AVM of the tongue base. We performed transfemoral transarterial embolization via both lingual arteries using Polyvinyl alcohol particles and Eudragit-E as non-adhesive glue material. Final angiograms after embolization revealed a small residual nidus fed by the right facial artery mental branch, but shunt flow was markedly reduced. This vascular malformation was removed after a day of TAE(transarterial embolization). The patients symptom was improved and relapse has not been confirmed though 18 months have passed since the surgery.

　Using classification proposed by Mulliken and Glowacki, vascular anomalies are divided into two groups: hemangiomas and vascular malformations (AVM/F, arterial, venous, capillary, lymphatic and combined ). AVM/F is classified into high flow malformation. TAE is useful for high flow malformation and can be used as the sole treatment or as an adjunct. Treatment should be to eradicate nidus or fistula completely, which is the fundamental abnormality because even the smallest residual nidus will expand to cause recurrence. The treatment of Cranio-facial AVM's requires rigorous differential diagnosis and appropriate management . Inadequate treatment is thought to contribute to collateral flow and disease progression in advanced AVM, making further management difficult.