両側視床病変を呈し両側基底核に出血を来したテント部硬膜動静脈瘻の1例

Tentorial Dural Arteriovenous Fistula with Bithalamic Lesions and Bilateral Basal Ganglia Hemorrhage:A Case Report

Ⅰ．はじめに

　硬膜動静脈瘻（dural arteriovenous fistula：DAVF）は硬膜に発生する異常な動静脈短絡であり，上錐体静脈洞（superior petrosal sinus：SPS）を含むテント部DAVFは比較的少ない¹⁰⁾．テント部DAVFは出血にて発症することが多いが，DAVFのシャントから深部静脈への逆流を来し静脈灌流障害による症状を呈することもある⁶⁾．

　今回，われわれは認知機能低下症状で発症し意識障害を来したテント部DAVFの症例を経験した．両側視床の浮腫性変化と両側基底核の出血を認めた．DAVFによる静脈灌流障害と流出路の閉塞により引き起こされたと考えられた．このような経過をたどるDAVFは稀であり報告する．

　OBJECTIVE:We report an unusual case of tentorial dural arteriovenous fistula（DAVF）with bithalamic lesions and bilateral intracranial hemorrhage.

　CASE PRESENTATION:A 73-year-old man presented with lethargy and progressive cognitive decline. Imaging demonstrated bithalamic edematous lesions and bilateral basal ganglia hemorrhage in the right putamen and left internal capsule. Angiography revealed tentorial DAVF fed by both the internal and external carotid arteries. A shunted pouch was present in the superior petrosal sinus, and retrograde reflux drainage was see in the deep venous system, including the basal vein, vein of Galen, and internal cerebral veins with congestion. Initially, transarterial embolization was palliatively performed, and subsequently, a microsurgery achieved obliteration of the tentorial DAVF. Postoperatively, the bilateral thalamic changes disappeared, although sequela of the intracranial hemorrhage persisted.

　CONCLUSION:Deep venous congestion due to tentorial DAVF induced unusual bithalamic lesions and bilateral basal ganglia hemorrhage. Tentorial DAVF was treated with combined endovascular and surgical operations. Tentorial AVF is an aggressive vascular disease, and prompt diagnosis and treatment are necessary.