眼球結膜充血と眼球突出で発症したテント部硬膜動静脈瘻の1例

Tentorial Dural Arteriovenous Fistula Presenting with Ocular Symptoms:A Case Report

Ⅰ．はじめに

　テント部硬膜動静脈瘻は全頭蓋内硬膜動静脈瘻の約4.8%を占め^8,10,11)，出血や静脈性梗塞などの重篤な病態を呈することが多い．一方で，静脈鬱滞による静脈灌流障害に伴う巣症状で発症した報告も散見される．今回われわれは，充血と眼球突出の眼症状で発症したテント部硬膜動静脈瘻に対して，血管内治療および直達手術を行い，良好な転機を得ることができた1例を経験した．眼症状で発症した機序を中心に，文献的考察を加え報告する．

　Tentorial dural arteriovenous fistula（dAVF）is classified as Cognard 4 with a high risk of aggressive feature, such as intracranial hemorrhage, venous infarction, and intracranial hypertension. We report a rare case presenting with ocular symptoms caused by tentorial dAVF. A 59-year-old man presented with progressive chemosis and exophthalmos of his left eye. Angiography showed a tentorial dAVF that was primarily fed by the middle meningeal artery and the meningohypophyseal artery. The AVF drained into the superior ophthalmic vein and the cerebellar cortical vein via an enlarged petrosal vein. Because transarterial Onyx embolization resulted in incomplete obliteration of the fistula, he underwent microsurgery via a suboccipital approach to obliterate the shunt. Postoperative angiography showed complete obliteration of the shunt. His ocular symptoms rapidly cured. We present this rare case and discuss the pathomechanism associated with the development of ocular symptoms secondary to a tentorial dAVF from the viewpoint of microvascular anatomy.