脊髄動静脈奇形の治療—特に手術および人工塞栓術の適応について

Treatment and Prognosis of Spinal AVM

I．はじめに

　脊髄動静脈奇形の診断に関しては，従来の脊髄腔造影，選択的血管撮影に加えて，最近ではMRI，MRangiography等の補助的診断技術の飛躍的進歩がみられる．しかしながら，その治療に関してはmicrosurgicaltechnique，人工塞栓術の発達があるとはいえ，脊髄疾患の中でも依然として，最も治療困難な疾患のままであると言わざるをえない．われわれはこの10年間に脊髄動静脈奇形の診断にて，17例に治療を行っているが，現段階における治療手段の適応について検討を加えた．

Spinal arteriovenous malformation (AVM) is a relative-ly rare disease. We assessed the results of treatment of spinal AVM in 17 patients. Our classification was based on the radiographic appearance in selective spinal angio-grams. There were 3 cases of single coiled type AVM, 3 of juvenile type, 5 of glomus type, and 6 of so-called du-ral AVM. All three patients with single coiled type AVM underwent microsurgical resection of the AVM. All three with the juvenile type underwent artificial embo-lization. Both patients with glomus type and dural AVM were treated by either embolization and/or surgery. Magnetic resonance imaging and magnetic resonance angiography visualized the spinal AVM well, and were useful for diagnosis and post-treatment follow-up.