進行する脊髄症を呈したテント部硬膜動静脈瘻の1例

A Tentorial Dural Arteriovenous Fistula Presenting Progressive Myelopathy: A Case Report

はじめに

　テント部の硬膜動静脈瘻の多くは静脈洞を介さずに直接脳皮質静脈に還流するため頭蓋内出血や小脳・脳幹症状などの明瞭な臨床症状を呈することが多いが^1，2），脊髄症で発症する例は比較的稀である^3，4）。今回われわれは，進行する脊髄症を呈したテント部硬膜動静脈瘻の症例に対し血管内治療に続く直達手術を行い良好な結果を得た1例を経験したので，文献的考察を加え報告する。

Abstract

　We report a case of a dural arteriovenous fistula (DAVF) at the tentorium cerebelli, which presented progressive myelopathy.　A 68-year-old man with neurological deterioration of the cervical myelopathy visited our hospital.　T₂ weighted magnetic resonance (MR) imaging showed high signal area and edema from the medulla to the upper thoracic spinal cord with flow voids on the dorsal surface of the cord.　Angiography showed right tentorial DAVF, which was supplied by the right meningohypophyseal trunk, the middle meningeal artery, the accessory meningeal artery, and was drained into the posterior spinal veins.　The patient underwent right retrosigmoid suboccipital craniotomy, then disruption of the fistula was performed by using micro Doppler sonography following endovascular obliteration of the main feeders.　Postoperative angiography showed complete obliteration of the fistula.　His daily functioning gradually improved up to 6 months after the surgery.

　Tentorial DAVFs with clinical manifestation of myelopathy are rare.　Considering its aggressive nature, early surgical treatment could be necessary.

(Received: November 17,2010,Accepted: December 18,2010)