広範な静脈洞血栓症に続発した多発性硬膜動静脈瘻の1例

Multiple dural arteriovenous fistulas following extensive sinus thrombosis:a case report

I．はじめに

　硬膜動静脈瘻（以下，DAVF）は頭蓋内動静脈奇形の10-15％^9）と稀な疾患であり，さらに多発例は極めて稀とされている^3）．今回，広範な静脈洞血栓症を伴ったDAVFの塞栓術後の経過中別の3カ所に発生した多発性DAVFの1例を経験した．このような静脈洞血栓症に続発した多発例の報告はいまだかつてなく，今だ議論の絶えないDAVFの発生機序を推定する上で興味深い例であると思われたので文献的考察を加え報告する．

A 43-year-old man suffered generalized convulsions following severe headache. Initial angiography showed a dural arteriovenous fistula (DAVF) involving the right transverse-sigmoid sinus, and no contrast filling of the superior sagittal sinus, bilateral transverse sinuses, the left sigmoid sinus and the straight sinus. The di-agnosis was extensive sinus thrombosis associated with DAVF. Transarterial embolization was performed for the DAVF. The follow-up angiography at 7 days post-embolization showed no contrast filling of the DAVF.But the follow-up angiography at 6 months disclosed the appearance of multiple DAVF's involving the su-perior sagittal sinus, the left transverse sinus and the straight sinus. Each DAVF was supplied by different dural arteries. Coagulation tests revealed deficiency of plasma protein S.

The pathogenesis of DAVF is controversial. But our case suggests that multiple isolated lesions indicated the presence of a congenital dural vascular abnormality, which was transformed to multiple DAVF's by sinus thrombosis.