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Neurological Surgery No Shinkei Geka Volume 47, Issue 4 （April 2019）

Neurological Surgery 脳神経外科 47巻4号（2019年4月発行）

Japanese English

研究

TVEにより頚部痛が消失したanterior condylar confluent dural AVFに関する病態の検討 Consideration of the Mechanism for Anterior Condylar Confluent Dural AVF Diagnosed with Neck Pain 内田賢一 ^1,2 , 保格宏務 ² , 青柳盟史 ² , 詫磨裕史 ^1,2 , 古館隆太郎 ² , 三井英央 ³ , 廣田暢夫 ² Kenichi UCHIDA ^1,2 , Hiromu HOKAKU ² , Chikashi AOYAGI ² , Yuushi TAKUMA ^1,2 , Ryutarou FURUDATE ² , Hideo MITSUI ³ , Nobuo HIROTA ² ¹千葉脳神経外科病院脳神経外科 ²横須賀市立うわまち病院脳神経外科 ³横浜市立大学整形外科 ¹Department of Neurosurgery, Chiba Neurosurgical Clinic ²Department of Neurosurgery, Yokosuka City Uwamachi Hospital ³Department of Orthopaedic Surgery, Yokohama City University キーワード： anterior condylar confluent dural arteriovenous fistula , crowned dense syndrome , neck pain , transvenous embolization Keyword: anterior condylar confluent dural arteriovenous fistula , crowned dense syndrome , neck pain , transvenous embolization pp.419-427

発行日 2019年4月10日 Published Date 2019/4/10

DOI https://doi.org/10.11477/mf.1436203955

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Ⅰ．緒　　言

　Anterior condylar confluent dural arteriovenous fistula（ACC-dAVF）は従来稀な疾患とされてきたが，画像診断や疾患認知度の高まりにより診断される頻度が増えてきている．その症状としては，耳鳴り，眼症状，舌下神経麻痺などが報告されているが，頚部痛を症状としての報告はない．今回われわれは連続症例として頚部痛を認めるACC-dAVFを経験しtransvenous embolization（TVE）にて症状消失したことより，これを報告する．

　OBJECTIVE:Anterior condylar confluent dural arteriovenous fistula（ACC-dAVF）constitutes 3.7% of the total dAVF cases reported and has been regarded as a rare disease in the past. However, encounters with this disease are increasing due to MRI and awareness of this condition. The symptoms of this disease have been reported as tinnitus（75%), ocular symptoms（31%), sublingual nerve palsy（12%), spinal cord symptoms（11%), and intracranial bleeding（5%). Here, we report our identification of a case of ACC-dAVF, which is different from conventional reports, and the associated findings.

　CASE PRESENTATIONS:We experienced a series of 3 cases of ACC-dAVF with the chief complaint of neck pain. The symptoms in all three patients disappeared after transvenous embolization. Based on the pathophysiology of cervical pain, we presumed that the blood flow dynamics of the odontoid arcade was involved. As expected, after the blood flow near the transverse ligament of the atlas was normalized the symptoms disappeared.

　CONCLUSION：We could not find previous reports of ACC-dAVF where the main symptom was cervical pain. We report the possibility of a mechanism of dAVF different from those reported previously.