側頭頭頂筋に発生した先天性動静脈奇形の1治験例

A case of congenital AVM in temporoparietal muscle

I．はじめに

　頭蓋外に発生する先天性の動静脈奇形（AVM）の中で，頭皮下でありながら頭部の筋肉内にみられるAVMは頭皮に限局するscalp AVMと異なり，多数の細いfeederが網目状に存在することにより，治療が困難とされている^11,17）．

　われわれは，側頭頭頂筋に発生した先天性AVMに，浅側頭動脈より分枝したfeederに動脈瘤を合併した1例を手術的に根治させ得たので若干の文献的考察とともに報告する．

A rare case with coexistent congenital scalp AVM in the temporoparietal muscle and a saccular aneurysm of the main feeder is presented.

A 47-year-old female was admitted with the com-plaint of a right gradually expanding and painful pre-auricular mass. Physical examination showed a round, tender and compressible tumor measuring 3×3cm in the right pre-auricular region, and there was bruit on the mass. Pre-and Post-constrast CT scans showed a slightly enhanced extracranial mass in the right tempor-al subcutaneous region. MR imaging showed a flow void mass both on T1 and T2 weighted images. Selec-tive external carotid angiogram revealed multiple feed-ers deriving from the superficial temporal artery (STA) and the abnormal vascular networks. And also the saccular aneurysm was detected in the main feeder of the STA.

Under a diagnosis of scalp AVM, it was totally re-moved with the temporoparietal muscle, and the aneurysmal neck was ligated. Histopathological ex-amination revealed AVM.

She was discharged on the 17th postoperative day with no deficits.

Based on our experience and a review of the litera-ture, the treatment of choice is embolization for scalp AVM localized in the skin alone and surgical total re-moval for AVM embedded in the muscle.