特発性内頸動脈海綿静脈洞瘻に対し顔面および眼角静脈経由で治療した1例

Treatment of Spontaneous Carotid-cavernous Fistula by the Transvenous Approach via the Facial and Angular Route

I．はじめに

　特発性内頸動脈海綿静脈洞瘻（CCF）の治療は，経静脈的塞栓術により海綿静脈洞内を塞栓する方法が主流である^1,4．代表的な海綿静脈洞への到達経路としては，内頸静脈から下錐体静脈洞（IPS）を経由するか，もしくは上眼静脈（SOV）を直接穿刺する方法がある^3,8．しかし，到達経路の状況によっては，治療に難渋することも多い．今回われわれは，顔面静脈および眼角静脈からSOVに到達し良好な治療結果が得られた特発性CCFの1例を経験したので，若干の文献的考察を加えてこれを報告する．

We report a case of a patient with a spontaneous carotid-cavernous sinus fistula (CCF) who was suc-cessfully treated by the facial vein approach. This 66-year-old female had a 3-month history of right che-mosis and exophthalmos. Angiograms showed a spontaneous right CCF with primary drainage via the su-perior ophthalmic vein. As both inferior petrosal sinuses were hypoplastic, the transvenous approach couldnot be used to gain access to the right cavernous sinus. With effort, we were able to traverse the sharpangle at the corner of the angular vein and the superior ophthalmic vein with a microcatheter.