耳下腺内に及んだ頬部動静脈奇形に対する段階的塞栓硬化療法の1例

Experience with Stepwise Embolic Sclerotherapy for Buccal Arteriovenous Malformation Involving the Parotid Gland

はじめに

　動静脈奇形（arteriovenous malformation：以下，AVM）は毛細血管を介さない動静脈の異常吻合であり，動静脈シャントを単一ないしは複数有し，シャント部は異常血管の集合体であるnidusを形成している。AVMは全身の至る所に生じるが，発生部位によって症状も異なり，治療時期や治療戦略もさまざまである。

　特に頭頸部領域の発生は，整容面ならびに機能面への配慮などから血管内治療がしばしば選択されるが，失明や脳梗塞などの重篤な合併症に加え，皮膚壊死や顔面神経麻痺などにも十分な留意が必要で，病態を見据えた慎重な治療計画が必要になる 1）2）。

　今回われわれは，頬部に生じたAVMに対し，病態を十分に検討したうえで，段階的に塞栓療法と硬化療法を施行し，良好な治癒経過を得ることができた。本症例の治療経過に若干の文献的考察を加え，報告を行う。

　Arteriovenous malformations (AVMs) are abnormal arteriovenous anastomoses with shunts, and they form a nidus. Although an AVM can occur all over the body, the symptoms differ depending on the site of occurrence, and the treatment timing and strategy also vary. Endovascular treatment is often selected as the approach to AVMs in the head and neck region due to cosmetic and functional considerations. An AVM requires careful attention, and it is necessary to select the optimal treatment plan that considers the AVMʼs pathology.

　Arteriovenous malformations in the parotid gland and superficial lesions in particular require more careful consideration, but we have observed that for lesions that are caused mainly by an arteriovenous fistula (AVF), a favorable course of treatment can be obtained with stepwise embolization sclerotherapy. In the present patientʼs case, we performed stepwise embolization and sclerotherapy for an AVM in the cheek, and the patient exhibited a good healing course. Staged lesion control resulted in superficial erosions and focal alopecia, but no serious complications such as extensive skin necrosis or facial paralysis occurred.

　A joint review meeting by physicians in multiple fields (including interventional radiology [IVR] specialists) was effective in this patientʼs case, and in our experience comprehensive team-based medical care has been very important.