術後過灌流症候群を来した出血発症の円蓋部硬膜動静脈瘻（Cognard typeⅣ）の1例

Postoperative Hyperperfusion in a Patient with a Dural Arteriovenous Fistula Associated with Intracerebral Hemorrhage: A Case Report

Ⅰ．はじめに

　硬膜動静脈瘻（dural arteriovenous fistula：dAVF）の外科的治療の適応は，脳皮質静脈への逆流を伴う症候性例で孤立した静脈洞にシャントがある場合，シャント血流が静脈洞への流出がなく直接脳表静脈に逆流している場合や根治的血管内治療が困難な場合である．

　われわれは出血発症の左後頭葉円蓋部硬膜動静脈瘻に対し手術を施行したが，術後過灌流症候群を認めたため，文献学的考察を加え報告する．

　A 60-year-old male complained of a severe headache and developed generalized convulsions. He was drowsy at the time of admission and a neurological examination revealed aphasia and right hemianopsia. Plain computed tomography (CT) revealed an intracerebral hematoma in the left occipital lobe. He was treated conservatively, the hematoma passed without increasing and his symptoms gradually improved. Angiography showed a dural arteriovenous fistula (dAVF) in the left occipital region, which was classified as type Ⅳ based on Cognard and a varix of the draining vein. He was treated with direct surgery and obliteration of the draining vein. The color of the red vein changed to blue after disconnection of the fistulas by electrocoagulation. However, he experienced aphasia and loss of memory 2 days after the operation. CT and MRI revealed no change, but postoperative ¹²³I-IMP SPECT demonstrated temporal hyperperfusion in this region. The present report describes a case of transient hyperperfusion occurring after treatment for a dAVF associated with an intracerebral hemorrhage.