脳幹部動静脈奇形の外科的治療—4例の直達手術の経験

Surgical Treatment of Arteriovenous Malformations in the Brain Stem

I．はじめに

　脳幹部動静脈奇形（以下脳幹部AVM）は発生頻度が低く，その直達手術も困難なものとされてきた^14,18）．しかし，診断技術の進歩やmicrosurgeryの発達により，徐徐に摘出成功例の報告も増えている．特に1975年にDrakeにより，nidusが実質外（epipial）にある例では神経脱落症状を発生させることなしに摘出可能であることが示されたことは，脳幹部AVMの手術的治療法にとっては大きな進歩であった^6）．

　著者らはこれまでに4例の脳幹部AVMに対して直達手術を行ったので報告し，その手術的治療を中心に考察する．

The authors report the surgical removal of four arte-riovenous malformations (AVM's) in the brain stem causing hemorrhage. These included two intra-axial and two extra-axial AVM's. Three of the four were situated at the pons, and the remaining one in the pos-terior medullary velum. Complete surgical removal was obtained in the two extra-axial cases and in one of the intra-axial cases. The patient in whom complete remov-al was not obtained received partial embolization ther-apy with the remaining feeder being coagulated surgi-cally. No patient was made permanently worse after surgery. One patient, in a comatose state on admission, died, while the remaining three patients showed useful recovery. These data indicate that surgical therapy with or without endovascular surgery appears to be possible for some AVM's and can be performed at an accept-able risk.