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Neurological Surgery No Shinkei Geka Volume 29, Issue 7 （July 2001）

Neurological Surgery 脳神経外科 29巻7号（2001年7月発行）

Japanese English

症例

脳幹部thrombosed AVMの1例 A Case of Thrombosed Arteriovenous Malformation in the Brain Stem 佐々木久里 ¹ , 清水夕貴 ¹ , 氏家弘 ¹ , 久保長生 ¹ , 堀智勝 ¹ Kuri SASAKI ¹ , Yuki SHIMIZU ¹ , Hiroshi UJIIE ¹ , Osami KUBO ¹ , Tomokatsu HORI ¹ ¹東京女子医科大学脳神経センター脳神経外科 ¹Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University キーワード： angiographically occult vascular malformation（AOVM） , thrombosed arteriovenous malformation（AVM） , brain stem Keyword: angiographically occult vascular malformation（AOVM） , thrombosed arteriovenous malformation（AVM） , brain stem pp.653-657

発行日 2001年7月10日 Published Date 2001/7/10

DOI https://doi.org/10.11477/mf.1436902070

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Abstract 文献概要
1ページ目 Look Inside

I．はじめに

　近年の画像診断，microsurgeryおよび術中モニタリングの進歩によって，脳幹部病変は脳外科医にとってchallengingな領域ではなく，積極的かつ安全に手術のなされる領域になってきた．最近では，1999年Porterら^11）が脳幹部海綿状血管腫86例，2000年Steinbergら^15）が脳幹部angiog-raphically occult vascular malformation（AOVM）42例の良好な外科的治療成績を報告している．今回われわれは，出血で発症した脳幹部血管病変に対して，海綿状血管腫の術前診断にて摘出術を行った．しかし術中に動脈性の出血を伴い摘出に苦労し，病理組織学的にthrombosed AVMと診断された．脳幹部thrombosed AVMの報告例はきわめてめずらしいため，文献的考察を加え報告する．

A rare operative case of thrombosed arteriovenous malformation (AVM) in the brain stem was reportedfocusing on its differential diagnosis from cavernous malformation. A 49-year-old woman had developedpontine hemorrhage twice during the last two years. She was diagnosed by neurologists as having caver-nous malformation in the brain stem, and then referred to our institute. Neurological examinations showedleft hemi motor and sensory disturbance, right abducent palsy and right auditory disturbance. A computedtomography (CT) scan revealed a high density mass in the brain stem considered as a hematoma withslight enhancement. Magnetic resonance imaging (MRI) revealed a high intenslty mass in T1 and T2weighted MRI with marginal hemosiderin rim, but neither flow void sign nor enhancement effect was de-tected. Angiography depicted no abnormal vasculature in the posterior fossa.

The patient underwent surgical resection of the lesion 43 days after a second hemorrhage. Midline sub-occipital craniotomy and the infrafacial route were chosen. Surgery was troubled by arteriai bleeding, andpathological examination revealed a thrombosed AVM. She newly developed right facial palsy, right abdu-cent palsy and disturbance of right conjugate gaze, but she is recovering step by step.

Although the radiological feature of thrombosed AVM in the brain stem is similar to that of cavernousmalformation, the operative procedure for thrombosed AVM is very difficult due to aggressive arterialbleeding that easily leads to surgical injury in the small surgical corridor in the brain stem. We reported arare case that was pathologically well identified as thrombosed AVM in the brain stem focusing on its dif-ferential diagnosis and surgical treatment.