静脈洞閉塞をともない脳内出血で発症した横・S状静脈洞部硬膜動静脈瘻の1例

Dural AVF of the Posterior Fossa Associated with Sinus Occlusion Presenting as Intracerebral Hemorrhage:Case report

Ι．はじめに

　硬膜動静脈瘻はその病因や進行機序について未だ一定した見解が得られておらず，その治療に難渋することが多い．静脈洞閉塞をともなう硬膜動静脈旗の頻度は16.3-72.7％^{1,3,6,11,14）}と報告されている．後頭蓋窩の硬膜動静脈瘻に限定すれば，その頻度はより高率であり，57.1-72.7％^1,6,11,14）とされている．静脈洞閉塞の意義について硬膜動静脈旗の発生原因とする報告^4,6）とその治癒過程とする報告^9,12,13）がある．今回，われわれは静脈洞閉塞をともない脳内出血で発症した後頭蓋窩硬膜動静脈痩の1例を経験したので文献的に若千の考察を加えて報告する．

A 69-year-old man was admitted because of sudden onset of consciousness disturbance. Neurological ex-amination on admission revealed slightly disturbed con-sciousness, sensory aphasia and right hemiparesis. CT scan disclosed a hematoma in the left posterior tempor-al lobe. Left carotid angiograms showed dural AVF of the transverse/sigmoid sinus fed mainly by the left occipital and posterior auricular arteries. On the angio-grams the left sigmoid sinus was completely occluded. This was associated with retrograde venous flow into the cortical veins, the superior petrosal sinus and the contralateral transverse sinus. After stabilizing the con-dition, we totally resected the dural AVE,- including the left transverse sinus. The postoperative course was un-eventful. Histopathological examination of the surgical-ly resected specimen revealed that the chiral A-V fistula per se existed in the sinus wall.