雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 37, Issue 12 （December 2009）

Neurological Surgery 脳神経外科 37巻12号（2009年12月発行）

Japanese English

症例

逆行性静脈造影でpseudo-occlusionを確認後transvenous embolizationで治療したisolated横静脈洞S状静脈洞硬膜動静脈瘻の1例 A Case of Dural Arteriovenous Fistula Mimicking Isolated Transverse-sigmoid Sinus Successfully Treated Via the Transvenous Route 松﨑粛統 ¹ , 渋谷肇 ^1,2 , 須磨健 ¹ , 杉谷雅人 ³ , 片山容一 ¹ Toshinori MATSUZAKI ¹ , Tadashi SHIBUYA ^1,2 , Takeshi SUMA ¹ , Masato SUGITANI ³ , Yoichi KATAYAMA ¹ ¹日本大学医学部脳神経外科学系神経外科学分野 ²相模原協同病院脳血管内治療科 ³相模原協同病院脳神経外科 ¹Division of Neurosurgery,Department of Neurological Surgery,Nihon University School of Medicine ²Department of Neuroendovascular Therapy,Sagamihara Kyodo Hospital ³Department of Neurosurgery,Sagamihara Kyodo Hospital キーワード： isolated sinus , transverse-sigmoid sinus , dural arteriovenous fistula , transvenous embolization Keyword: isolated sinus , transverse-sigmoid sinus , dural arteriovenous fistula , transvenous embolization pp.1221-1225

発行日 2009年12月10日 Published Date 2009/12/10

DOI https://doi.org/10.11477/mf.1436101073

PDF(651KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference

Ⅰ．はじめに

　硬膜動静脈瘻（dural arteriovenous fistula：DAVF）は，流入動脈と流出静脈およびシャント部位をよく評価した上で適切な治療法を選択することが重要である．近年経静脈的アプローチによる治療法は確立されつつあるが，cortical venous reflux（CVR）がありアプローチ可能な静脈洞の近位側，遠位側ともに閉塞してisolated sinusを呈している場合には治療に難渋することが多い．今回われわれは，isolated sinusを呈した横静脈洞S状静脈洞硬膜動静脈瘻（transverse-sigmoid sinus dural arteriovenous fistula：TS-DAVF）に対して逆行性静脈造影を行うことで，pseudo-occlusion（機能的閉塞）であることが確認でき，経静脈的塞栓術（transvenous embolization：TVE）を容易に行えたことで，良好な治療結果が得られた症例を経験したので文献的考察を加えて報告する．

　A 66-year-old man was admitted to our hospital suffering from a left temporo-occipital intracerebral hematoma with bilateral thin subdural hematomas. Neurological examinations revealed slightly decreased cognitive function. Cerebral angiography demonstrated a left transverse-sigmoid dural arteriovenous fistula (TS-DAVF) with cortical venous reflux. The main feeders of the TS-DAVF consisted of multiple branches of the left occipital artery, and the left affected transverse-sigmoid sinus was occluded at both ends，i.e. the affected sinus was isolated. Transvenous embolization (TVE) was performed under general anesthesia. A contralateral approach failed to reach the affected sinus so that an ipsilateral approach was attempted. Contrast material was injected from the left jugular bulb and the route to the affected sinus was visualized. We succeeded in passing both a microguidewire and a microcatheter through the stenosed proximal sigmoid sinus to the fistula area of the affected sinus. The affected sinus was occluded with multiple platinum coils. Post-treatment angiography revealed disappearance of the cortical venous reflux and improvement of the cerebral perfusion. It is a challenging operation to approach an affected sinus through an occluded sinus. However, some cases of isolated TS-DAVFs have the possibility of being treated by TVE via the occluded sinus similarly to cavernous sinus DAVFs.