多角的治療を行った多発性硬膜動静脈瘻の1例

A Case of Multiple Dural Arteriovenous Fistulas Treated by Multiple Modalities

Ⅰ．はじめに

　硬膜動静脈瘻（以下DAVF）はそのほとんどが単発病変で治療戦略は観血的手術，経動脈的塞栓術（以下TAE），経静脈的塞栓術（以下TVE），gamma knife unit（以下ガンマナイフ）やlinacによる放射線手術など多岐にわたる．多発性DAVFは稀であり^4,5,8,11)，治療は病態に応じて多角的に各治療方法を組み合わせることが重要となる⁴⁾．

　今回われわれは，多発性DAVFに対して観血的手術，TVE，ガンマナイフを用いて治療した1例を経験したので文献的考察を含め報告する．

　The authors report a rare case of multiple intracranial dural arteriovenous fistulas (DAVF) at separate sinuses. A 70-year-old man was introduced to our hospital complaining of visual disturbance due to bilateral choked disk,headache,and tinnitus. Initial angiography showed DAVFs involving the superior sagittal sinus and bilateral transverse-sigmoid sinuses,and the occlusion of the right jugular vein. The patient developed progressive impairment of visual activity and had high intracranial pressure (ICP) caused by venous hypertension. No cerebral alteration was seen on magnetic resonance imaging. To decrease the high ICP,surgical sinus isolation of the superior sagittal sinus was performed. After the surgery,transvenous embolization was performed to the right transverse-sigmoid sinus DAVF. Headache and tinnitus improved after these treatments,but visual activities rapidly declined and he experienced blindness in just a few months. Gamma knife radiosurgery was performed to the residual DAVFs.

　We discussed the etiology and treatment of the multiple DAVF,and reviewed past literatures.