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Neurological Surgery No Shinkei Geka Volume 23, Issue 9 （September 1995）

Neurological Surgery 脳神経外科 23巻9号（1995年9月発行）

Japanese English

症例

水頭症を合併した脊髄硬膜動静脈瘻の1例 A Case of Spinal Dural Arteriovenous Fistula Associated with Normal Pressure Hydrocephalus 増尾修 ^1,2 , 奥野孝 ¹ , 尾崎文教 ¹ , 寺田友昭 ¹ , 中井國雄 ¹ , 板倉徹 ¹ , 駒井則彦 ¹ Osamu MASUO ^1,2 , Takashi OKUNO ¹ , Fuminori OZAKI ¹ , Tomoaki TERADA ¹ , Kunio NAKAI ¹ , Toru ITAKURA ¹ , Norihiko KOMAI ¹ ¹和歌山県立医科大学脳神経外科 ²国保日高総合病院脳神経外科 ¹Department of Neurological Surgery, Wakayama Medical College キーワード： Spinal dural arteriovenous fistula , Intravascular surgery , Normal Pressure hydrocephalus Keyword: Spinal dural arteriovenous fistula , Intravascular surgery , Normal Pressure hydrocephalus pp.825-828

発行日 1995年9月10日 Published Date 1995/9/10

DOI https://doi.org/10.11477/mf.1436901086

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Abstract 文献概要
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I．はじめに

　脊髄硬膜動静脈瘻spinal dural arteiovenous fistula（AVF）は，一般に後天的疾患とされている^1-10）．今回，われわれは，この見解を強く支持するような頻回の腰椎穿刺の既往をもつ脊髄硬膜動静脈瘻を経験した．また本症例は，正常圧水頭症を合併していた．脊髄疾患に水頭症を伴った報告は多く見られるが，spinal dural AVFに水頭症を伴ったという報告はわれわれが検索し得た範囲ではみられなかった．spinal dural AVFが水頭症を合併した機序について，若干の文献的考察を加えて報告する．

A 62-year-old male presented with urinary inconti-nence, gait disturbance and dementia for 6 months.

Neurological examination revealed severe paraparesis (1/5), sensory disturbance below Th10, neurogenic bladder and absence of patellar and achilles tendon re-flexes.

CT scan showed mild brain atrophy and symmetrion, ventriculomegaly with periventricular lucency. Magnetic resonance imaging (MRI) showed a linear flow void lesion on the dorsal surface on the back of his swollen lower spinal cord. Myelography showed a filling defect and flow disturbance of contrast medium in lower thoracic levels, suggesting the presence of adhesive arachnoiditis. Spinal angiography demon-strated a fistula formation between dural branches of bilateral L4 lumbar arteries and ventral spinal and radi-cular veins on the surface of the dura mater of L4/5 levels.

Considering his past history of repeated lumbar puncture for tuberculous meningitis at the age of 22 years, a diagnosis of acquired spinal dural arteriove-nous fistula probably due to repeated lumbar puncture was made. Fistulas were embolized with N-butyl cya-noacrylate. And normal pressure hydrocephalus was treated by ventriculoperitoneal shunt. Follow-up CT scans showed a decrease of the size of the ventricular system.

Etiology of acquired spinal arteriovenous fistula has been reported. In the case, repeated lumbar puncture may be a possible cause of arteriovenous fistula in the lower spinal dura mater. However, the reason why it took so long to form a fistula after the lumbar puncture remains to be elucidated. We suggest that an increased protein concentration due to disturbance of cerebrospi-nal fluid flow might be a cause of normal pressure hyd-rocephalus (NPH).