血栓性静脈洞炎に続発したと考えられる硬膜動静脈瘻に対して血栓融解術を試みた1例

Dural arteriovenous fistula involving the superior sagittal and transverse-sigmoid sinuses, treated by thrombolysis:case report

I．はじめに

　硬膜動静脈瘻（以下DAVF）は全動静脈瘻の10-15％を占める^11）が，上矢状静脈洞部（以下SSS）に発生するものは稀である．われわれは，両側頸静脈孔部に高度の狭窄および閉塞を認め，横静脈洞—S状静脈洞部とSSSにDAVFを有する稀な症例を報告し，本疾患の発生機序および治療法について考察する．

A rare case of dural arteriovenous fistula (DAVF) in the superior sagittal sinus (SSS), the transverse sinus and the sigmoid sinus is reported.

A 64-year-old man, who had had an episode of tem-porary visual disturbance after moderate fever for a week about 20 years before, was aware of loss of visual acuity and reduced field of view in the right eye. When he was introduced to our outpatient service, increased intracranial pressure (ICP) was detected by lumbar puncture. Cerebral angiograms showed bilateral DAVFs both in the posterior fossa and the SSS con-comitant with thrombosis in the transverse sinus, sig-moid sinus and SSS. Afterwards, endovascular trans-arterial embolization through bilateral occipital, pos-terior auricular and left middle meningeal, superior tem-poral arteries was carried out. In addition, transvenous thrombolytic therapy using a catheter inserted into SSS resulted in the improvement of his visual problems. Although he was discharged at once, he was readmit-ted to our department with Foster Kennedy syndrome and increased ICP. Cerebral angiograms showed recur-rence of both DAVF and sinus thrombosis. Transarterial embolization was performed again resulting in a signifi-cant reduction of DAVF, and his visual acuity was rec-overed to a moderate degree.

The origin of DAVF is still controversial. Although two theories, “congenital” and “acquired”, are put for-ward, it has been thought that both factors play impor-tant roles. In our case, the patient had stenosis in the jugular canal portions of the sigmoid sinus. In addition, sinus thrombosis seemed to have occurred. It is thought that increased intrasinus pressure may have lead to communication with surrounding arteries through ex-isting dural vessels.

We applied transvenous thrombolytic therapy in this case. Our result suggests that we should consider this therapy for some cases of DAVF.