摘出術後19年目に，大型化して再発が認められた脳動静脈奇形の1症例

Marked Growth of Arteriovenous Malformation 19 Years after Resection; A case report

I．はじめに

　脳動静脈奇形（以下AVMと略す）が，その経過中に増大傾向を示す場合があることは従来より注目されていた^3-5,12,13）．しかしAVM摘出術直後の脳血管撮影において，明らかな残存AVMは認めなかったにもかかわらず，その数年後に再発が認められた症例の報告は少ない．

　最近われわれは，脳出血で発症したAVMの摘出術直後に施行した脳血管撮影で，main nidusの消失を確認し，AVMは摘出し得たと判断されたにもかかわらず，術後19年の間に残存したと思われるAVMが成長し，術前よりもはるかに巨大化して発見された症例を経験した．AVMの術後再発機序及びその診断，治療方針に関する考察を加えて報告する．

We report a case of arteriovenous malformation (AVM) which recurred as a giant AVM 19 years after resection.

At the age of 23, the patient underwent craniotomy for a small AVM with surrounding old hematoma in the right parietal lobe. The AVM was judged to have been removed completely on postoperative angiogra-phy, while abnormal small vessels were noted retro-spectively. He did well until 19 years later when he had seizures. Repeated angiography showed huge recurrent AVM at the operative site. Considering the risk in-volved in surgery, he was discharged from the hospital with anticonvulsants.

Recurrence of AVM after removal is rare, but pa-tients with AVM surgery should be followed up with CT and angiography for a long period of time.