成人慢性硬膜下血腫に対する超選択的中硬膜動脈撮影—経時的観察例

Superselective Angiographic Findings of Ipsilateral Middle Meningeal Artery of Chronic Subdural Hematoma in Adults

I．はじめに

　私共はこれ迄成人慢性硬膜下血腫（本症）症例に対し，超選択的中硬膜動脈撮影（本法）を行った結果，点状，斑状あるいは帯状の，大小且濃淡様々な異常血管網がほぼ必発して造影され，これが本症外膜に存在するmacrocapillary（MC）と推定されることを報告した^8）．今回は本法を経時的に施行する機会を得，興味ある所見を得たので報告する．

The authors reported the results of continuous superselective angiography of the ipsilateral middlemeningeal artery (MMA) in cases of chronic subdural hematoma (CSH) in adults. MMA angiography wasperformed twice, at an interval of approximately two weeks, in 3 cases of conservative and 1 case of sur-gical treatment. The features of MMA angiographic findings were diffuse dilatation of MMA andvisualization of scattered abnormal vascular networks (VN), which seemed to be macrocapillaries in theouter membrane of the CSH. In two Out of the three cases of conservative treatment, these VN revealed adynamic change temporarily and spatially, i.e. either enlargement or reduction. In one case with a long cli-nical course a stable MMA angiogram was seen. The operated case showed dramatic change on thesecond (postoperative) MMA angiogram. The VN around burr hole portion was huge and dark, and sever-al newly visualized small arteries penetrated the enlarged VN, which was thought to have been caused bythe operation.

The mean blood pressure in the MMA was 103mmHg.

The reason for the acute enlargement of the CSH might be explained as arterial bleeding into the hema-toma cavity, caused by rupture of thin walled macrocapillaries by direct arterial pressure.