脳室内出血にて発症した横-S状静脈洞硬膜動静脈瘻の1例

Dural Arteriovenous Fistula of the Transverse-sigmoid Sinus with Intraventricular Hemorrhage : a case report

I．はじめに

　横・S状静脈洞硬膜動静脈瘻（以下TS-DAVF）は，耳鳴りや頭痛などの軽微な症状で発症するものから，脳内出血を来たす重篤なものまで存在する^2）．われわれは比較的稀な脳室内出血で発症したTS-DAVFを経験した．症例を呈示しその臨床症状，循環動態，治療方法について検討する．

We report a case of dural arteriovenous fistula of the transverse-sigmoid sinus (TS-DAVF) with in-traventricular hemorrhage.

An 83-year-old woman presented with headache and vomiting. Neurological examination showed no de-fects. CT scans demonstrated intraventricular hemorrhage. Left external carotid angiograms showed a du-ral arteriovenous fistula of the isolated transverse-sigmoid sinus fed by the occipital and middle meningealarteries. The draining vein was the leptomeningeal vein. Left internal carotid angiograms demonstratedvenous congestion in the left temporal and occipital lobes. This case was grade 4 according to Lalwani'sclassification.

¹²³I-IMP SPECT revealed a low perfusion area in the left temporal and occipital regions. Dynamic CTscans revealed venous congestion in the left temporal and occipital regions. We considered that the venouscongestion was the cause of intraventricular hemorrhage.

Initially, we embolized the DAVF using a transarterial approach with liquid material. However, theembolization of the DAVF was not complete. Therefore, we treated the DAVF by sinus packing with coilsusing a small craniotomy.

Angiographic cure was obtained and the postoperative course was uneventful.

We discuss the clinical features, the hemodynamic findings and the management of this case.