前頭蓋窩硬膜動静脈瘻—3例の報告と文献的考察

Dural Arteriovenous Fistulae in the Anterior Cranial Fossa : Report of Three Cases

I．はじめに

　前頭蓋窩に発生する硬膜動静脈瘻（dural arter-iovenous fistula，以下DAVF）は，横・S状静脈洞や海綿静脈洞部に生じるDAVFと比較すると出血で発症することが多く，脳神経外科手術の対象になることが多い^12）．1993年12月1日の開院以来の6年3か月の間に3例の前頭蓋窩DAVFを経験したので特に成因を中心に文献的考察を加えて報告する．

Dural arteriovenous fistulae (DAVF's) in the anterior cranial fossa are uncommon. We encountered three patients with DAVF's in the anterior cranial fossa and reviewed the pertinent literature with regard to the etiology. All patients are middle-aged males. Two of three patients had massive intracranial hemor-rhage, subarachnoidal hemorrhage in one and subdural hemorrhage in the other. One patient had a rup-tured middle cerebral artery aneurysm and DAVF at the anterior cranial fossa was detected only inciden-tally. Angiographically, blood supplies were from the bilateral enlarged anterior ethmoidal arteries. These drained into the superior sagittal sinus via dilated frontal cortical veins. In all the patients, coagulation of the fistulous connections was carried out and the postoperative courses were uneventful. Angiographies re-vealed complete disappearance of the DAVF's.

In conclusion, compared to cases of DAVF's in the other locations, DAVF's of the anterior cranial fossa are more likely to be brought on by sudden massive intracranial hemorrhage, and should be treated, even if asymptomatic, at the time of diagnosis. Surgical obliteration of the fistulous connection is sufficient treat-ment for DAVF in the anterior cranial fossa. Literature review strongly suggests that DAVF's involving the anterior cranial fossa are acquired lesions.