出血にて発症した非外傷性頭皮動静脈瘻の1例

A Case of Hemorrhagic Non Traumatic Arteriovenous Fistula of the Scalp

I．はじめに

　頭皮動静脈奇形・瘻は稀な疾患で，脳動静脈奇形の約20分の1の程度に過ぎない．拍動性の腫瘤・耳鳴で発症することが多く，出血にて発症した報告は非常に少ない．治療法も症例が少ないため，流入動脈のligation^4,8），外科的切除^5），endo-vascular surgery^7,10），それらの組み合わせ^1,6），など報告されているが，確立されてはいない．われわれは出血を伴った症例に対し，頸部外頸動脈を頸部にて一時的に遮断し，外科的切除のみで満足できる結果が得られたので報告する．

Arteriovenous malformation of the scalp is an uncommon disease and treatment for this lesion is difficultand controversial. A twenty-three-year-old male, who reported no history of head trauma, presented withspontaneous hemorrhage from the left temporal scalp. Neurologically he was normal except the tinnitus.Left external carotid angiography demonstrated arteriovenous malformation fed by the superior temporaland posterior auricular arteries. A dilated tortuous occipital artery was also recognized. The lesions wereable to be surgically resected, alleviating intraoperative massive hemorrhage by proximal temporary occlu-sion of the external carotid artery at the left neck. Small feeding arteries from the meningeal artery whichwere not recognized on preoperative angiography were found at surgery. The arteriovenous fistula wassuccessfully resected without any cosmetic problem.