横-S状静脈洞部硬膜動静脈瘻の根治的経静脈塞栓術後に発生した海綿静脈洞部硬膜動静脈瘻の1例

A Case of Cavernous Sinus Dural Arteriovenous Fistula after Transverse-Sigmoid Sinus Dural Arteriovenous Fistula Treatment with Radical Transvenous Coil Embolization

Ⅰ．はじめに

　硬膜動静脈瘻（dural arteriovenous fistula：dAVF）は，海綿静脈洞（cavernous sinus：CS）部と横-S状静脈洞（transverse-sigmoid siuns：TS）部に好発し，そのほとんどは単発病変である．根治的な経静脈的塞栓術（transvenous embolization：TVE）を施行後に，時間的・空間的に多発することは非常に稀で，過去の報告も極めて少ない^2,3,5,6,8)．今回われわれは，左横-S状静脈洞部dAVF（TSdAVF）に対してTVEを施行し，その3年後に同側の海綿静脈洞部dAVF（CSdAVF）を発症した1例を経験した．この順序で発生したdAVFの報告は過去にみられず，dAVFの発生機序解明に関しても重要な症例と思われるので，文献的考察を加えて報告する．

　Purpose:We report a case of cavernous sinus dural arteriovenous fistula（dAVF）that developed after the treatment of a transverse-sigmoid sinus dAVF using transvenous embolization（TVE).

　Case presentation:A 72-year-old woman presented with headache and left-sided tinnitus. Angiography demonstrated the presence of a left transverse-sigmoid sinus dAVF. After TVE, the patient's symptoms completely disappeared. Three years later, she complained of left-sided tinnitus and diplopia, and angiography revealed the presence of a left cavernous sinus dAVF. We performed transvenous coil embolization, and the dAVF disappeared.

　Conclusions:TVE has been widely recognized as an effective treatment for dAVF. However, dAVF may develop at a different location after TVE in a few cases. A long-term follow-up is therefore recommended.