顔面動静脈奇形の治療

Treatment of Facial Arteriovenous Malformation

I．はじめに

　頭皮・顔面には豊富なvascular networkが存在するため，この部に発生した動静脈奇形（以下AVM）の中には最新の技術をもってしても治療に難渋する症例が少なくない．われわれは最近，頭皮・顔面のAVMを3例経験し，主に血管内手術による治療を行い，ほぼ満足すべき結果を得たので，症例を呈示するとともに，本疾患の治療法とその問題点に関し検討を加える．

Arteriovenous malformations (AVMs) of the face are notoriously difficult lesions to manage because of the abundant vascular network in this region. We report three cases in which AVMs of the face were treated with endovascular embolization. Two cases with small AVM of the face and auricle were treated with direct puncture of the nidus and embolization with a small amount of n-butyl-cyanoacrylate (NBCA). In the third patient with a large AVM of the cheek, the external carotid artery (ECA) of which had been previously li-gated surgically, percutaneous direct puncture of the ECA was performed. Superselective catheterization of each of the feeding arteries and embolization with a small amount of NBCA was then achieved. All cases demonstrated clinical and angiographical improvement. In two cases with a small AVM of the face and auricle, complete obstruction of the nidus was achieved. Direct puncture of the nidus and embolization with a small amount of NBCA was a safe and effective technique for the treatment of facial AVM.