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Neurological Surgery No Shinkei Geka Volume 49, Issue 1 （January 2021）

Neurological Surgery 脳神経外科 49巻1号（2021年1月発行）

Japanese English

症例

下位脳神経麻痺で指摘された頚静脈孔部動静脈瘻の1例 A Case of Internal Jugular Arteriovenous Fistula Presenting as Lower Cranial Nerve Palsy 佐瀬泰玄 ¹ , 小野寺英孝 ¹ , 中村歩希 ¹ , 川口公悠樹 ¹ , 榊原陽太郎 ¹ , 田中雄一郎 ² Taigen SASE ¹ , Hidetaka ONODERA ¹ , Homare NAKAMURA ¹ , Kimiyuki KAWAGUCHI ¹ , Yohtaro SAKAKIBARA ¹ , Yuichiro TANAKA ² ¹聖マリアンナ医科大学横浜市西部病院脳神経外科 ²聖マリアンナ医科大学脳神経外科 ¹Department of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital ²Department of Neurosurgery, St. Marianna University School of Medicine キーワード： ascending pharyngeal artery , extracranial arteriovenous fistulae , internal jugular vein Keyword: ascending pharyngeal artery , extracranial arteriovenous fistulae , internal jugular vein pp.199-203

発行日 2021年1月10日 Published Date 2021/1/10

DOI https://doi.org/10.11477/mf.1436204376

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Ⅰ．はじめに

　硬膜動静脈瘻（dural arteriovenous fistula：dAVF）の発生部位としてanterior condylar confluent（ACC）部は時に見受けられる．一方で，その近傍に発生する稀な頭蓋外動静脈瘻として上行咽頭動脈-内頚静脈瘻（ascending pharyngeal artery-internal jugular vein fistula：APA-IJV AVF）がこれまでに5例報告されている^{1-3, 7, 8）}．今回は，下位脳神経麻痺で発見されたAPA-IJV AVFを経験し，経静脈的塞栓術（transvenous embolization：TVE）で治療したので報告し，考察を加える．

　INTRODUCTION：Although arteriovenous fistulas（AVFs）are typically located within the cranium, there are several published reports documenting rare cases of extracranial AVFs between the ascending pharyngeal artery（APA）and the internal jugular vein（IJV）. Herein, we report the case of a patient with APA-IJV AVFs who presented with symptoms of lower cranial nerve palsy that was treated with transvenous embolization（TVE）.

　CASE：A 53-year-old man presented with chief complaints of numbness in the left oral cavity and a temple headache. Magnetic resonance angiography showed an abnormal signal in the left jugular bulb. An AVF was suspected；digital subtraction angiography revealed the presence of a shunt from the jugular branch of the APA to the jugular bulb which was accompanied by regurgitation into the inferior petrosal sinus（IPS）and sigmoid sinus（SS）. Numbness in the oral cavity was diagnosed as lower cranial nerve palsy associated with increased pressure within the jugular foramen. As the nature of the AVF（single or multi-hole）was uncertain, a therapeutic TVE was planned. Microcatheters were guided into the IPS and SS, and TVE was performed using a double-catheter technique. Regurgitation into the IPS resolved；embolization via the APA was not performed, and symptoms improved postoperatively.

　CONCLUSIONS：AVFs involving the APA and IJV are identified infrequently and there are only a few published case reports describing this vascular anomaly. Most reported cases were single-hole AVF and were treated with trans-arterial embolization via the APA. As noted in the present case, APA-IJV AVF can also be treated by TVE.