塞栓術後に硬膜動静脈瘻が発生した新生児ガレン大静脈瘤の1例

A Case of Vein of Galen Aneurysmal Malformation with a Newly Developed Dural Arteriovenous Fistula after Successful Embolization

Ⅰ．はじめに

　ガレン大静脈瘤（vein of Galen aneurysmal malformation：VGAM）は，ガレン静脈の前駆血管であるmedian vein of prosencephalonの拡張を伴う高流量の動静脈シャントで，主に胎生後期から小児期にかけて心不全や水頭症などにて発症する稀な疾患である．今回，心不全を呈した新生児VGAMに対し経動脈的塞栓術を行い，病変は閉塞し良好な結果を得たが，閉塞した流出路近傍に新たに硬膜動静脈瘻（dural arteriovenous fistula：DAVF）が発生した症例を経験したので報告する．

　We report a case of vein of Galen aneurysmal malformation (VGAM) with a newly developed dural arteriovenous fistula (AVF) subsequent to successful embolization. A male neonate diagnosed as VGAM with prenatal ultrasonography and MRI presented severe cardiac and respiratory failure soon after birth. Five sessions of transarterial embolization using NBCA were performed during the first 6 months of his life. The shunt flow was effectively reduced and heart failure was resolved after the treatment. Follow-up angiography performed 2.5 years after the last embolization revealed complete obliteration of VGAM and newly developed small dural AVF on the wall of the thrombosed falcorial sinus. We believe that the dural AVF in this case was caused by local venous hypertension or induction of angiogenic factor during the thrombosing process of VGAM.