受傷部位と反対側に生じた外傷性中硬膜動静脈瘻の1例

A Case of Traumatic Middle Meningeal Arteriovenous Fistula on the Side of the Head Opposite to the Injured Side

Ⅰ．はじめに

　外傷性中硬膜動静脈瘻は比較的稀な疾患であり^1,2,4-13)，多くは頭蓋骨骨折に伴い，直下の中硬膜動脈が損傷されて生じる．しかし，頭蓋骨骨折を認めない中硬膜動静脈瘻の報告は非常に稀であり^7,11,12)，頭蓋骨骨折に伴う中硬膜動静脈瘻とは発症機転が異なると考えられる．

　今回われわれは，頭部外傷後3カ月後に眼症状で発症し，受傷部位と反対側に外傷性中硬膜動静脈瘻を認めた症例を経験したので，発症機転などについて文献的考察を加え報告する．

　A rare case of a traumatic middle meningeal arteriovenous fistula on the side of the head opposite to the injured side was reported. A 21-year-old man was admitted to our hospital after a traffic accident in which the right side of his head was hit. CT scans and MR images on admission showed a right temporal bone fracture, traumatic subarachnoid hemorrhage, and a left frontal lobe contusion. Three months after the head injury, he complained of tinnitus and exophthalmos. One year after the head injury, left external carotid angiograms showed a dural arteriovenous fistula fed by the left dilated middle meningeal artery and draining into the middle meningeal vein. Early filling of the sphenoparietal sinus, cavernous sinus, superior ophthalmic vein, and the cortical vein were also detected. Transarterial embolization of the left middle meningeal fistula was performed, resulting in the disappearance of the lesion. The postoperative course was uneventful.