くも膜下出血で発症したextrasinusal typeの後頭蓋窩硬膜動静脈瘻の1例
「はじめに」 頭蓋内硬膜動静脈瘻(dAVF)は多彩な病態を含む疾患で, その原因は不明であり, 臨床的には診断や治療に難渋する症例も少なくない. 特に, くも膜下腔の架橋静脈に直接流出する“extrasinusal type”のdAVFは出血や静脈うっ滞による症状出現の危険性が高く, 出血例では再出血の危険性も高い. 今回われわれは, くも膜下出血(SAH)で発症し, 再出血をきたした後頭蓋窩の“extrasinusal type”のdAVFの1例を経験したので, 文献的考察を加えて報告する. 「症例」 患者:80歳, 男性. 既往歴:高血圧症, 珪肺. 現病歴:突然の後頭部痛を自覚して近医を...
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| Published in | 脳卒中の外科 Vol. 40; no. 4; pp. 257 - 261 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中の外科学会
2012
日本脳卒中の外科学会 |
| Online Access | Get full text |
| ISSN | 0914-5508 1880-4683 |
| DOI | 10.2335/scs.40.257 |
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| Abstract | 「はじめに」 頭蓋内硬膜動静脈瘻(dAVF)は多彩な病態を含む疾患で, その原因は不明であり, 臨床的には診断や治療に難渋する症例も少なくない. 特に, くも膜下腔の架橋静脈に直接流出する“extrasinusal type”のdAVFは出血や静脈うっ滞による症状出現の危険性が高く, 出血例では再出血の危険性も高い. 今回われわれは, くも膜下出血(SAH)で発症し, 再出血をきたした後頭蓋窩の“extrasinusal type”のdAVFの1例を経験したので, 文献的考察を加えて報告する. 「症例」 患者:80歳, 男性. 既往歴:高血圧症, 珪肺. 現病歴:突然の後頭部痛を自覚して近医を受診し, CTで右小脳橋角槽に限局するSAHがみられ(Fig.1A, B, C), 同院脳神経外科に入院した. 入院後, ただちに脳血管撮影が行われたが両側内頚動脈撮影および椎骨動脈撮影で出血源の特定には至らず, unknown origin SAHとして保存的に加療された. |
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| AbstractList | 「はじめに」 頭蓋内硬膜動静脈瘻(dAVF)は多彩な病態を含む疾患で, その原因は不明であり, 臨床的には診断や治療に難渋する症例も少なくない. 特に, くも膜下腔の架橋静脈に直接流出する“extrasinusal type”のdAVFは出血や静脈うっ滞による症状出現の危険性が高く, 出血例では再出血の危険性も高い. 今回われわれは, くも膜下出血(SAH)で発症し, 再出血をきたした後頭蓋窩の“extrasinusal type”のdAVFの1例を経験したので, 文献的考察を加えて報告する. 「症例」 患者:80歳, 男性. 既往歴:高血圧症, 珪肺. 現病歴:突然の後頭部痛を自覚して近医を受診し, CTで右小脳橋角槽に限局するSAHがみられ(Fig.1A, B, C), 同院脳神経外科に入院した. 入院後, ただちに脳血管撮影が行われたが両側内頚動脈撮影および椎骨動脈撮影で出血源の特定には至らず, unknown origin SAHとして保存的に加療された. |
| Author | 溝井, 和夫 柴田, 憲一 柳澤, 俊晴 佐々木, 順孝 |
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| References | 5) Davies MA, TerBrugge K, Willinsky R, et al: The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg 85: 830-837, 1996 1) Aminoff MJ: Vascular anomalies in the intracranial dura mater. Brain 96: 601-612, 1973 3) Brown RD Jr, Wiebers DO, Nichols DA: Intracranial dural arteriovenous fistulae: angiographic predictors of intracranial hemorrhage and clinical outcome in nonsurgical patients. J Neurosurg 81: 531-538, 1994 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) Halbach VV, Higashida RT, Hieshima GB, et al: Dural fistulas involving the transverse and sigmoid sinuses: results of treatment in 28 patients. Radiology 163: 443-447, 1987 10) Lasjaunias P, Geibprasert S, Pereira V, et al: Classification of dural arteriovenous shunts (DAVS) based on the craniospinal epidural venous drainage of the central nervous system and adjacent bony structures. Jpn J Neurosurg (Tokyo) 17: 356-361, 2008 12) Nabors MW, Azzam CJ, Albanna FJ, et al: Delayed postoperative dural arteriovenous malformations. Report of two cases. J Neurosurg 66: 768-772, 1987 15) Singh V, Smith WS, Lawton MT, et al: Risk factors for hemorrhagic presentation in patients with dural arteriovenous fistulae. Neurosurgery 62: 628-635, 2008 14) Piske RL, Lasjaunias P: Extrasinusal dural arteriovenous malformations. Report of three cases. Neuroradiology 30: 426-432, 1988 13) Newton TH, Cronqvist S: Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 93: 1071-1078, 1969 4) Cognard C, Gobin YP, Pierot L, et al: Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194: 671-680, 1995 8) Grisoli F, Vincentelli F, Fuchs S, et al: Surgical treatment of tentorial arteriovenous malformations draining into the subarachnoid space. Report of four cases. J Neurosurg 60: 1059-1066, 1984 11) Mitsuhashi Y, Aurboonyawat T, Pereira VM, et al: Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas. Clinical article. J Neurosurg 111: 889-899, 2009 6) 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 7) Geibprasert S, Pereira V, Krings T, et al: Dural arteriovenous shunts: a new classification of craniospinal epidural venous anatomical bases and clinical correlations. Stroke 39: 2783-2794, 2008 |
| References_xml | – reference: 15) Singh V, Smith WS, Lawton MT, et al: Risk factors for hemorrhagic presentation in patients with dural arteriovenous fistulae. Neurosurgery 62: 628-635, 2008 – reference: 7) Geibprasert S, Pereira V, Krings T, et al: Dural arteriovenous shunts: a new classification of craniospinal epidural venous anatomical bases and clinical correlations. Stroke 39: 2783-2794, 2008 – reference: 5) Davies MA, TerBrugge K, Willinsky R, et al: The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg 85: 830-837, 1996 – reference: 11) Mitsuhashi Y, Aurboonyawat T, Pereira VM, et al: Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas. Clinical article. J Neurosurg 111: 889-899, 2009 – 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: 1) Aminoff MJ: Vascular anomalies in the intracranial dura mater. Brain 96: 601-612, 1973 – reference: 8) Grisoli F, Vincentelli F, Fuchs S, et al: Surgical treatment of tentorial arteriovenous malformations draining into the subarachnoid space. Report of four cases. J Neurosurg 60: 1059-1066, 1984 – reference: 3) Brown RD Jr, Wiebers DO, Nichols DA: Intracranial dural arteriovenous fistulae: angiographic predictors of intracranial hemorrhage and clinical outcome in nonsurgical patients. J Neurosurg 81: 531-538, 1994 – reference: 10) Lasjaunias P, Geibprasert S, Pereira V, et al: Classification of dural arteriovenous shunts (DAVS) based on the craniospinal epidural venous drainage of the central nervous system and adjacent bony structures. Jpn J Neurosurg (Tokyo) 17: 356-361, 2008 – reference: 4) Cognard C, Gobin YP, Pierot L, et al: Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194: 671-680, 1995 – reference: 9) Halbach VV, Higashida RT, Hieshima GB, et al: Dural fistulas involving the transverse and sigmoid sinuses: results of treatment in 28 patients. Radiology 163: 443-447, 1987 – reference: 13) Newton TH, Cronqvist S: Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 93: 1071-1078, 1969 – reference: 12) Nabors MW, Azzam CJ, Albanna FJ, et al: Delayed postoperative dural arteriovenous malformations. Report of two cases. J Neurosurg 66: 768-772, 1987 – reference: 14) Piske RL, Lasjaunias P: Extrasinusal dural arteriovenous malformations. Report of three cases. Neuroradiology 30: 426-432, 1988 – reference: 6) 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 |
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| Title | くも膜下出血で発症したextrasinusal typeの後頭蓋窩硬膜動静脈瘻の1例 |
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