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Neurological Surgery No Shinkei Geka Volume 41, Issue 6 （June 2013）

Neurological Surgery 脳神経外科 41巻6号（2013年6月発行）

Japanese English

症例

経静脈的塞栓術で治癒した群発頭痛様の症状を呈した海綿静脈洞部硬膜動静脈瘻の1例 Cluster-like Headache Cause by Cavernous Sinus Dural Arteriovenous Fistula, Cured by Transvenous Embolization: A Case Report 蔵本要二 ^1,2 , 足立秀光 ¹ , 坂井信幸 ^1,2 , 上野泰 ¹ , 坂井千秋 ² , 今村博敏 ¹ , 石川達也 ¹ , 菊池晴彦 ¹ Yoji KURAMOTO ^1,2 , Hidemitsu ADACHI ¹ , Nobuyuki SAKAI ^1,2 , Yasushi UENO ¹ , Chiaki SAKAI ² , Hirotoshi IMAMURA ¹ , Tatsuya ISHIKAWA ¹ , Haruhiko KIKUCHI ¹ ¹神戸市民病院機構神戸市立医療センター中央市民病院脳神経外科 ²先端医療センター病院脳血管内治療科 ¹Department of Neurosurgery, Kobe City Hospital Organization, Kobe City Medical Center General Hospital ²Division of Neuro Endovascular Therapy, Institute of Biomedical Research and Innovation Hospital キーワード： cluster-like headache , cavernous sinus , dural AVF , transvenous embolization Keyword: cluster-like headache , cavernous sinus , dural AVF , transvenous embolization pp.493-498

発行日 2013年6月10日 Published Date 2013/6/10

DOI https://doi.org/10.11477/mf.1436102012

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　群発頭痛は一次性頭痛であり一側頭痛と流涙・鼻漏などの自律神経症状を伴い，その痛みは高度である．今回，海綿静脈洞部硬膜動静脈瘻から群発頭痛様の症状のみを呈し，血管内手術で治療後症状が改善し，疼痛に対する投薬が不要となった1例を経験したので報告する．

　We report a unique case of cavernous sinus（CS）-dural arteriovenous fistula（dAVF）with cluster headache-like ophthalmalgia without chemosis and exophthalmos, that was successfully treated by transvenous embolization.

　A 25-year-old man presented with severe right cluster headache-like ophthalmalgia and could not get complete relief of symptoms by medical treatment. MRI showed a hyper-intensity signal in the right cavernous sinus and cerebral angiography revealed Barrow type D cavernous sinus dural arteriovenous fistula, which is thought to be the cause of ophthalmalgia. Percutaneous transvenous embolization of the anterior part of the right CS and superior ophthalmic vein was performed and complete obliteration of dAVF was obtained followed by complete cure of cluster headache-like ophthalmalgia.

　We can detect neither the recurrence of dAVF on MRI nor any clinical symptom after 23 months of the treatment.

　This is the first clinical presentation of cluster headache-like ophthalmalgia caused by CS dAVF and it emphasizes the unique and important potential relationship between them.