錐体路近傍のAVM摘出術に対してneuronavigation systemが有効であった1例

Removal of an Arteriovenous Malformation Near the Pyramidal Tract Using the Neuronavigation System: A Case Report

Ⅰ．は じ め に

　近年，腫瘍性病変の摘出術のみならず，脳動静脈奇形（arteriovenous malformation：AVM）摘出術に対してもfunctional MRI（fMRI）やdiffusion tensor tractography（DTT）を併用したneuronavigationの有効性が報告されている．今回，錐体路近傍のAVM摘出術に対して，これらの技術を用いて後遺症なく病変摘出が可能であった1例を経験したので，文献的考察を加えて報告する．

　A 20-year-old female presented with sudden severe headaches. Computed tomography showed an intraventricular hemorrhage and slightly dilated lateral ventricles. Her neurological examinations revealed no abnormalities. Magnetic resonance (MR) images and cerebral angiography revealed arteriovenous malformation (AVM) in the right parietal lobe. The size of the nidus was 1.8 cm, and it was located in the deep white matter. It was fed by middle cerebral arteries and drained by the vein of Galen. Diffusion tensor tractography (DTT) demonstrated that the right pyramidal tract was situated close to the nidus. The AVM was surgically resected completely, without any complications, using intraoperative neuronavigation image guidance. Neuronavigation images combined with DTT are useful for surgical resection of AVM that is located close to the pyramidal tract.