進行性に巨大なVarixを形成した上錐体静脈洞部硬膜動静脈瘻の1例
「はじめに」上錐体静脈洞部(superior petrosal sinus, SPS)の硬膜動静脈瘻(dAVF)は, 頭蓋内のdAVFの中でも比較的まれであるが, 出血発症が多いことで知られている1)3). 今回, SPS部のdAVFに伴う静脈瘤(varix)が比較的短期間に増大し, 小脳と脳幹への圧迫症状を示した1例を経験した. varixの切除を要するようなdAVFはまれであり, 考察を加え報告する. 「症例」症例:61歳の男性. 主訴:頭痛, 意識障害. 既往歴:数年前に交通外傷があり, その後統合失調症と診断され近医にて入院加療中であった. 現病歴:1ヵ月前に頭痛のために近医で頭部CT...
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| Published in | 脳卒中の外科 Vol. 36; no. 5; pp. 399 - 403 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中の外科学会
2008
日本脳卒中の外科学会 |
| Online Access | Get full text |
| ISSN | 0914-5508 1880-4683 |
| DOI | 10.2335/scs.36.399 |
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| Abstract | 「はじめに」上錐体静脈洞部(superior petrosal sinus, SPS)の硬膜動静脈瘻(dAVF)は, 頭蓋内のdAVFの中でも比較的まれであるが, 出血発症が多いことで知られている1)3). 今回, SPS部のdAVFに伴う静脈瘤(varix)が比較的短期間に増大し, 小脳と脳幹への圧迫症状を示した1例を経験した. varixの切除を要するようなdAVFはまれであり, 考察を加え報告する. 「症例」症例:61歳の男性. 主訴:頭痛, 意識障害. 既往歴:数年前に交通外傷があり, その後統合失調症と診断され近医にて入院加療中であった. 現病歴:1ヵ月前に頭痛のために近医で頭部CTが施行されたが, 異常は指摘されなかった(Fig. 1A). 今回突然の後頭部痛と意識障害が出現し, 近医を救急受診した. 頭部CTにて出血を認めたため当院を紹介された. 入院時神経学的所見:来院時の意識レベルは傾眠でJCSI-1, 構音障害と右共同偏視および左小脳失調を認めた. |
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| AbstractList | 「はじめに」上錐体静脈洞部(superior petrosal sinus, SPS)の硬膜動静脈瘻(dAVF)は, 頭蓋内のdAVFの中でも比較的まれであるが, 出血発症が多いことで知られている1)3). 今回, SPS部のdAVFに伴う静脈瘤(varix)が比較的短期間に増大し, 小脳と脳幹への圧迫症状を示した1例を経験した. varixの切除を要するようなdAVFはまれであり, 考察を加え報告する. 「症例」症例:61歳の男性. 主訴:頭痛, 意識障害. 既往歴:数年前に交通外傷があり, その後統合失調症と診断され近医にて入院加療中であった. 現病歴:1ヵ月前に頭痛のために近医で頭部CTが施行されたが, 異常は指摘されなかった(Fig. 1A). 今回突然の後頭部痛と意識障害が出現し, 近医を救急受診した. 頭部CTにて出血を認めたため当院を紹介された. 入院時神経学的所見:来院時の意識レベルは傾眠でJCSI-1, 構音障害と右共同偏視および左小脳失調を認めた. |
| Author | 永廣, 信治 松崎, 和仁 木内, 智也 佐藤, 浩一 松原, 俊二 |
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| References | 5) Duffau H, Lopes M, Janosevic V, et al: Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature. J Neurosurg 90: 78-84, 1999 14) Nagahiro S, Hamada J, Sakamoto Y, et al: Follow-up evaluation of dissecting aneurysms of the vertebrobasilar circulation by using gadolinium-enhanced magnetic resonance imaging. J Neurosurg 87 (3) : 385-390. 1997 8) Hanaoka M, Satoh K, Satomi J, et al: Microcatheter pull-up technique in the transvenous embolization of an isolated sinus dural arteriovenous fistula: technical note. J Neurosurg 104: 974-977, 2006 10) King WA, Martin NA: Intracerebral hemorrhage due to dural arteriovenous malformations and fistulae. Neurosurg Clin N Am 3: 577-590, 1992 3) Chandler HC Jr, Friedman WA: Successful radiosurgical treatment of a dural arteriovenous malformation: case report. Neurosurgery 33: 139-142, 1993 12) Malik GM, Pearce JE, Ausman JI, et al: Dural arteriovenous malformations and intracranial hemorrhage. Neurosurgery 15: 332-339, 1984 13) 松島俊夫：後頭蓋窩の微小外科解剖と手術―解剖研究から実践手術へ―．東京：サイメッド・パブリケーションズ，2006, pp37-41 1) Awad IA, Little JR, Akrawi WP, et al: Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72: 839-850, 1990 15) Nakstad PH, Sakke SJ, Hald JK, et al: Embolization of intracranial arteriovenous malformations and fistulae with polyvinyl alcohol particles and platinum fiber coils. Neuroradiology 34: 348-351, 1992 4) Collice M, D'Aliberti G, Talamonti G, et al: surgical interruption of leptomeningeal drainage as treatment for intracranial dural arteriovenous fistulae without dural sinus drainage. J Neurosurg 84: 810-817, 1996 18) Soleau SW, Schmidt R, Stevens S, et al: Extensive experience with dural sinus thrombosis. Neurosurgery 52 (3) : 534-544, 2003 2) Borden JA, Wu JK, Shucart WA: A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82: 166-179, 1995 9) Iwamuro Y, Nakahara I, Higashi T, et al: Tentorial dural arteriovenous fistula presenting symptoms due to mass effect on the dilated draining vein: case report. Surg Neurol 65 511-515, 2006 7) Halbach VV, Higashida RT, Hieshima GB, et al: Treatment of dural arteriovenous malformations involving the superior sagittal sinus. AJNR Am J Neuroradiol 9: 337-343, 1989 6) Einhäupl KM, Villringer A, Meister W, et al: Heparin treatment in sinus venous thrombosis. Lancet 7: 597-600, 1991 17) Satoh K, Satomi J, Nakajima N, et al: Cerebellar hemorrhage caused by dural arteriovenous fistula: a review of five cases. J Neurosurg 94: 422-426, 2001 11) Lewis AI, Tomsick TA, Tew JM Jr, et al: Management of tentorial dural arteriovenous malformations: transarterial embolization combined with stereotactic radiation or surgery. J Neurosurg 81: 851-859, 1994 16) Roy D, Raymond J: The role of transvenous embolizaton in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 40: 1133-1144, 1997 |
| References_xml | – reference: 17) Satoh K, Satomi J, Nakajima N, et al: Cerebellar hemorrhage caused by dural arteriovenous fistula: a review of five cases. J Neurosurg 94: 422-426, 2001 – reference: 8) Hanaoka M, Satoh K, Satomi J, et al: Microcatheter pull-up technique in the transvenous embolization of an isolated sinus dural arteriovenous fistula: technical note. J Neurosurg 104: 974-977, 2006 – reference: 10) King WA, Martin NA: Intracerebral hemorrhage due to dural arteriovenous malformations and fistulae. Neurosurg Clin N Am 3: 577-590, 1992 – reference: 2) Borden JA, Wu JK, Shucart WA: A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82: 166-179, 1995 – reference: 7) Halbach VV, Higashida RT, Hieshima GB, et al: Treatment of dural arteriovenous malformations involving the superior sagittal sinus. AJNR Am J Neuroradiol 9: 337-343, 1989 – reference: 9) Iwamuro Y, Nakahara I, Higashi T, et al: Tentorial dural arteriovenous fistula presenting symptoms due to mass effect on the dilated draining vein: case report. Surg Neurol 65 511-515, 2006 – reference: 1) Awad IA, Little JR, Akrawi WP, et al: Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72: 839-850, 1990 – reference: 4) Collice M, D'Aliberti G, Talamonti G, et al: surgical interruption of leptomeningeal drainage as treatment for intracranial dural arteriovenous fistulae without dural sinus drainage. J Neurosurg 84: 810-817, 1996 – reference: 6) Einhäupl KM, Villringer A, Meister W, et al: Heparin treatment in sinus venous thrombosis. Lancet 7: 597-600, 1991 – reference: 11) Lewis AI, Tomsick TA, Tew JM Jr, et al: Management of tentorial dural arteriovenous malformations: transarterial embolization combined with stereotactic radiation or surgery. J Neurosurg 81: 851-859, 1994 – reference: 12) Malik GM, Pearce JE, Ausman JI, et al: Dural arteriovenous malformations and intracranial hemorrhage. Neurosurgery 15: 332-339, 1984 – reference: 14) Nagahiro S, Hamada J, Sakamoto Y, et al: Follow-up evaluation of dissecting aneurysms of the vertebrobasilar circulation by using gadolinium-enhanced magnetic resonance imaging. J Neurosurg 87 (3) : 385-390. 1997 – reference: 16) Roy D, Raymond J: The role of transvenous embolizaton in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 40: 1133-1144, 1997 – reference: 5) Duffau H, Lopes M, Janosevic V, et al: Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature. J Neurosurg 90: 78-84, 1999 – reference: 13) 松島俊夫：後頭蓋窩の微小外科解剖と手術―解剖研究から実践手術へ―．東京：サイメッド・パブリケーションズ，2006, pp37-41 – reference: 15) Nakstad PH, Sakke SJ, Hald JK, et al: Embolization of intracranial arteriovenous malformations and fistulae with polyvinyl alcohol particles and platinum fiber coils. Neuroradiology 34: 348-351, 1992 – reference: 18) Soleau SW, Schmidt R, Stevens S, et al: Extensive experience with dural sinus thrombosis. Neurosurgery 52 (3) : 534-544, 2003 – reference: 3) Chandler HC Jr, Friedman WA: Successful radiosurgical treatment of a dural arteriovenous malformation: case report. Neurosurgery 33: 139-142, 1993 |
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| Title | 進行性に巨大なVarixを形成した上錐体静脈洞部硬膜動静脈瘻の1例 |
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