くも膜下出血で発症した特発性内頚動脈海綿静脈洞瘻の1例

A Case of Direct Carotid-Cavernous Fistula Presenting with Subarachnoid Hemorrhage

Ⅰ．はじめに

　外傷性，特発性を含め内頚動脈海綿静脈洞瘻（carotid-cavernous fistula：CCF）の症状としては眼球突出，結膜充血，拍動音聴取などが主であるが，今回われわれは重篤な頭部外傷や眼症状の既往がなく，重症くも膜下出血にて発症したdirect CCFの1例を経験したので報告する．

　We report a case of longstanding asymptomatic direct carotid-cavernous fistula (CCF) which caused fatal subarachnoid hemorrhage (SAH).

　A 91-year-old female with no history of previous head trauma and optic symptoms presented acute subarachnoid hemorrhage. Angiography revealed a left direct carotid-cavernous fistula draining only into the contralateral cavernous sinus with leptomeningeal venous reflux and small varix on the pontine bridging vein. The affected cavernous sinus was markedly dilated and there was no septum between the left cavernous sinus and the internal carotid artery. The patient underwent transvenous coil embolization for intercavernous sinus and leptomeningeal venous reflux was successfully obliterated and opacification of the varix was diminished. The past history of this patient and angiographical findings strongly suggest long standing asymptomatic CCF caused SAH.