Japanese
English
- 有料閲覧
- Abstract 文献概要
- 1ページ目 Look Inside
- 参考文献 Reference
Ⅰ.はじめに
脊髄perimedullary arteriovenous fistula(PMAVF)は,広義の脊髄動静脈奇形の一型であり,前脊髄動脈や後脊髄動脈が脊髄表面でnidusを介さず脊髄静脈へのシャントを来すものである1-6,8,9).発症の病態としては,静脈圧の上昇による脊髄症状4,5,8,19)やくも膜下出血5,8,19)が一般的であるが,稀に静脈瘤や異常拡張した静脈によるmass effectのために脊髄の圧迫を来す場合がある.これらはgiant perimedullary arteriovenous fistula(GPMAVF)として報告3,4,6,7,9,10,12,14-17,20-25)されている.
今回われわれは,PMAVFの異常拡張した流出静脈が上部胸髄~頚髄を広範囲にわたって圧迫しprogressive myelopathyを来したthoracocervical GPMAVFを経験した.その臨床経過および治療に関して,文献的考察を加え報告する.
A 43-year-old woman with progressive gait disturbance and dysesthesia of the limbs and trunk visited our hospital. Upon examination, a thoracocervical giant perimedullary arteriovenous fistula(GPMAVF)was detected. The GPMAVF was fed by both of the highest intercostal arteries and the thyrocervical trunk. The dilated drainage vein widely compressed the spinal cord from the upper thoracic to the cervical regions. Transarterial embolization with n-butyl 2-cyanoacrylate was performed, and the fistula was completely obliterated. The dilated drainage vein was thrombosed, and it decreased in size after treatment. The patient's symptoms and magnetic resonance imaging results significantly improved. We suggest that endovascular treatment is effective for GPMAVFs, given sufficient analysis of the anatomical architecture.
Copyright © 2013, Igaku-Shoin Ltd. All rights reserved.