頭蓋内出血で発症した海綿静脈洞部硬膜動静脈瘻の1例

A Case of Cavernous Sinus Dural Arteriovenous Fistula Presenting with Intracranial Hemorrhage

Ⅰ．はじめに

　海綿静脈洞部硬膜動静脈瘻（cavernous sinus dural arteriovenous fistula：CS-dAVF）は眼球突出，眼球結膜充血・浮腫，拍動性耳鳴が三徴といわれ，その他眼球運動障害による複視や頭痛を起こすことが多いが，脳出血，静脈性梗塞，脳浮腫などのいわゆるaggressive featureを呈することは少ないことが知られている⁸⁾．

　今回われわれは，頭蓋内出血で発症したCS-dAVFの1例を経験した．同様の報告は過去に13例しかなく，比較的稀な症例であるため文献的考察を加え報告する．

　Intracranial cavernous sinus dural arteriovenous fistula (CS-dAVF) rarely causes intracranial hemorrhage. We report a case of CS-dAVF presenting with intracranial hemorrhage. A 62-year-old man presented tonic clonic convulsion with consciousness disturbance and was transferred to our hospital. CT scan revealed subarachnoid hemorrhage and right frontal subcortical hemorrhage. Angiography revealed right CS-dAVF which drained only into the vein of the right sylvian fissure. Transvenous embolization was performed using detachable coils. After embolization,CS-dAVF had completely disappeared and the patient was discharged without any symptom. We summarized the fourteen reported cases,including ours,of CS-dAVF with intracranial hemorrhage. All of them had retrograde drainage through cerebral veins.