硬膜動静脈瘻の消失に伴い静脈洞が再開通した静脈洞閉塞の1例

Recanalization of dural sinus occlusion following the disappearance of dural arteriovenous fistula:report of a case

I．はじめに

　硬膜動静脈瘻（以下D-AVF）の成因，病態についてはいまだ不明な点が多い．とりわけ後頭蓋窩D-AVFでは，しばしば静脈洞の閉塞性病変を合併しており，その因果関係が論議されている^{3,5,7,9,18,20,21）}．

　最近，静脈洞閉塞を伴った後頭蓋窩D-AVFの1例を経験し，経時的脳血管撮影で，D-AVFの消失にともない，静脈洞の再開通が確認された．後頭蓋窩D-AVFの成因について示唆に富む症例と考えられたので，若干の文献的考察を加えて報告する．

A 73-year-old female was admitted to our hospital because of disturbed consciousness and left-sided motor weakness. Computed tomographic scans demonstrated a hemorrhagic infarction in the right parietal region. Right carotid angiograms showed both the posterior portion of the superior sagittal sinus (SSS) and the en-tire left transverse sinus simultaneously occluded. Left carotid angiograms revealed an enlarged occipital artery, which had direct communications to the left sig-moid sinus and the superior petrosal sinus. These find-ings were consistent with dural arteriovenous fistula (D-AVF). The laboratory examinations yieled normal results. The patient was managed conservatively with glyceol and anticonvulsants for four weeks and even-tually recovered with complete resolution of hemi-paresis. Follow-up angiography carried out 6 weeks la-ter showed the SSS, partially stenotic, but recanalized with no evidence of venous congestion. The D-AVF still remained opacified, but there was a marked reduc-tion in retrograde flow to the sigmoid sinus. Further re-peated angiograms obtained at 10 months after the onset confirmed complete recanalization of the SSS and disappearance of the D-AVF. From the timing of the angiographies, we considered that the sinus occlusion was caused by the high arterial flow to the fistula and its disappearance made recanalization of SSS possible.