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Ⅰ.はじめに
脊髄硬膜動静脈瘻(spinal dural arteriovenous fistula:SDAVF)は,椎間孔近傍の硬膜上で動静脈短絡を形成する比較的稀な疾患であるが,脊髄動静脈奇形の60~80%を占める1,5,10,13).また,中高年男性に多くみられ,venous congestionによる下肢の脱力・感覚障害といった緩徐進行性の発症形態をとることが多く,脊椎変性疾患との鑑別が重要となる5,8,14).SDAVFは,脊髄のあらゆる高位に発生しうるが,胸腰椎レベルに最も多く発生することが知られている7,8,11).ときに,頭蓋頚椎移行部や頚椎,仙骨部発生のSDAVFの報告も散見されるが,これらの病変は通常の肋間動脈および腰動脈撮影のみでは診断できず,適切な早期診断が未だ困難といえるSDAVFにおいて,さらに見逃されやすい病変といえる4,12,16-19).今回,われわれは,稀なSDAVFの1つである仙骨部病変に対する治療経験について報告する.
Spinal dural arteriovenous fistula (SDAVF) in the sacral region is relatively rare and remains difficult to diagnose because of the uncommon origin of its feeder. It also has higher incidence of recurrence than usual thoraco-lumbar lesion and needs subsequent treatment. We reviewed 51 cases of SDAVF over the past 10 years. Especially in patients with sacral lesion,clinical features and the findings on spinal angiography were analyzed. Four patients (7.8%) had SDAVF in the sacral region. In all cases,SDAVF were supplied by the lateral sacral artery. Multiple feeders were observed in 3 (75%) out of 4 patients and 2 patients (50%) had multiple fistulas. Endovascular embolizations were performed in all patients,and neurological symptoms were improved in two patients (50%) and the other two were stabilized (50%). There was no recurrence during a follow-up period of 3 months to 8 years. We should keep in mind that SDAVF in the sacral region can have multiple shunts and feeders derived from the lateral sacral artery.
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