開頭血腫術後，開頭部位から離れた箇所に発生した前頭蓋窩部硬膜動静脈瘻の1症例

A Case of Dural Arteriovenous Fistula in the Anterior Cranial Fossa that Developed Remote from the Craniotomy Site after Surgery

Ⅰ．はじめに

　硬膜動静脈瘻（dural arteriovenous fistula：dAVF）は比較的稀な病態であり，その成因に関しては不明な点も多い．先天性と後天性の2つに分類されるが，その多くは後天性と考えられており，静脈洞血栓症，外傷，感染症，術後など二次性に続発するものが報告されている^10,12,16,21)．

　今回われわれは，脳内出血に対する開頭血腫術後に開頭部位とは離れた箇所に発生した無症候性のdAVFの症例を経験したので，文献的考察を加え報告する．

　Dural arteriovenous fistula（dAVF）is relatively rare, and its etiology remains uncertain. Generally, dAVF is thought to be acquired and has been reported to develop secondary to sinus thrombosis, head injury, infection, and surgery.

　We report a rare case of dAVF in the anterior cranial fossa that developed remote from the craniotomy site after surgery. A 52-year-old man underwent surgery for hypertensive intracerebral hemorrhage 4 years prior. Perioperative imaging modalities demonstrated no abnormal vascular malformation except for an un-ruptured anterior communicating artery aneurysm. Four years later, follow-up magnetic resonance angiography showed abnormal vascular malformation in the anterior cranial fossa, and cerebral angiography demonstrated dAVF. dAVF and aneurysm were successfully treated. Possible formation of a dAVF should be considered after craniotomy.