脊髄動静脈奇形病変に対する外科治療

Surgical Treatment for Spinal Arteriovenous Malformation

Ⅰ はじめに

　脊髄動静脈奇形（spinal arteriovenous malformation：spinal AVM）は，動脈血が静脈に病的に流出することにより，くも膜下出血，髄内出血，あるいはうっ血性脊髄症などを来す疾患群の総称である^1）．本稿では，spinal AVMの分類，脊髄血管解剖，診断のポイント，そして外科治療の実際について概説する．

　In this paper, we outlined the diagnostic and treatment strategies for spinal arteriovenous malformations, focusing on dural and perimedullary arteriovenous fistula（AVF）. In many patients with spinal arteriovenous malformations, the symptoms are non-specific. Therefore, we consider it is critical to detect the signal flow voids in the enlarged spinal veins using MRI. An accurate understanding of the vascular structures is indispensable for deciding appropriate treatment strategies. Hence, performing an angiography is essential. Regarding treatment, whether to select surgical or endovascular treatment for AVF depends largely on the institution's protocols. However, the treatment should always be based on an accurate diagnosis.