脊髄円錐部および仙骨部に発生した多発脊髄動静脈瘻の1例

Multiple Spinal Arteriovenous Fistulas Occurring at Conus Medullaris and Dura of the Sacral Region : A Case Report

I．はじめに

　脊髄動静脈奇形において離れた2カ所以上の部位に病変が存在する症例は過去に報告が少なく非常に稀であると考えられる．われわれは脊髄円錐部に硬膜内髄外動静脈瘻（intradural perimedul-lary AVF），仙骨部に硬膜動静脈瘻（dural AVF）の2つの病変を有する症例を経験し，治療する機会を得たので若干の文献的考察を加え報告する．

Multiple arteriovenous fistulas (AVFs) of the spine are rare. The authors reported a case of spinalAVFs occurring at two separate sites including the conus medullaris and the dura of the sacral region.

A 31-year-old man had a two-week history of progressive low back pain, mild gait disturbance anddysuria. Examination revealed mild motor weekness of both legs, disturbance of superficial sensibility be-low the L4 dermatome on both sides and dysuria. Sensory disturbance was most obvious in the perianal re-gion, although deep sensibility was not disturbed. Magnetic resonance images (MRIs) of the spine showedmany serpentine flow void signals from the lower thoracic region to the sacral region, and spinal arteriove-nous malformations were suspected. Selective spinal angiography revealed two AVFs at the separate sitesincluding intradural perimedullary AVF at the conus medullaris and dural AVF at the sacral region. Thedural AVF of the sacral region was fed by the left lateral sacral artery and drained through the dilated corona' venous plexus to Th 11 level.

Embolization with N-butylcyanoacrylate (NBCA) was performed using an endovascular procedure forboth AVFs. Although recanalization of the dural AVF of the sacral region was confirmed by angiographytwo weeks later, it was treated successfully by the surgical approach.