硬膜動静脈瘻に対する定位放射線手術の最前線 ─有効性・安全性の最新レビューと難治例への挑戦

頭蓋内硬膜動静脈瘻（intracranial dural arteriovenous fistulas：DAVF）は，硬膜動脈と静脈洞/脳静脈との異常なシャントを特徴とする疾患で，脳出血や非出血性神経障害を引き起こす可能性がある．主たる治療法には血管内治療や直達術があり，近年は定位放射線手術（stereotactic radiosurgery：SRS）の有効性が報告されている．本総説はDAVFに対するSRSの最新のエビデンスをレビューし，その有効性と安全性を検証することを目的とした．SRSは高精度の局所放射線治療法である．SRSによるDAVFの5年累積完全閉塞率は67-89％と報告され，合併症...

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Published in脳卒中の外科 Vol. 53; no. 1; pp. 1 - 5
Main Authors 梅川, 元之, 小泉, 聡, 長谷川, 洋敬, 新谷, 祐貴, 片野, 厚人, 齊藤, 延人
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本脳卒中の外科学会 2025
日本脳卒中の外科学会
Subjects
cortical venous reflux
dural arteriovenous fistulas
sinus patency
stereotactic radiosurgery
Online AccessGet full text
ISSN0914-5508
1880-4683
DOI10.2335/scs.53.1

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Abstract 頭蓋内硬膜動静脈瘻（intracranial dural arteriovenous fistulas：DAVF）は，硬膜動脈と静脈洞/脳静脈との異常なシャントを特徴とする疾患で，脳出血や非出血性神経障害を引き起こす可能性がある．主たる治療法には血管内治療や直達術があり，近年は定位放射線手術（stereotactic radiosurgery：SRS）の有効性が報告されている．本総説はDAVFに対するSRSの最新のエビデンスをレビューし，その有効性と安全性を検証することを目的とした．SRSは高精度の局所放射線治療法である．SRSによるDAVFの5年累積完全閉塞率は67-89％と報告され，合併症はまれ（0-3％）であった．治療効果の予測因子としては，皮質静脈逆流の有無や病変局在が関連しており，多施設後方視的研究においても同様に良好な結果が確認された．特に，横-S状静脈洞部DAVFに対しては，正常静脈還流に寄与する罹患静脈洞温存が担保され，Borden type Iの病変に対してはとりわけ有効な治療法とする報告もある．出血性高流量シャント例や多発病変・再発症例といった“難治性”DAVFに対しては，血管内治療や直達術との補完的組み合わせで SRS は有効な治療選択肢となり得るであろう．
AbstractList 頭蓋内硬膜動静脈瘻(intracranial dural arteriovenous fistulas:DAVF)は, 硬膜動脈と静脈洞/脳静脈との異常なシャントを特徴とする疾患で, 脳出血や非出血性神経障害を引き起こす可能性がある. 主たる治療法には血管内治療や直達術があり, 近年は定位放射線手術(stereotactic radiosurgery:SRS)の有効性が報告されている. 本総説はDAVFに対するSRSの最新のエビデンスをレビューし, その有効性と安全性を検証することを目的とした. SRSは高精度の局所放射線治療法である. SRSによるDAVFの5年累積完全閉塞率は67-89%と報告され, 合併症はまれ(0-3%)であった. 治療効果の予測因子としては, 皮質静脈逆流の有無や病変局在が関連しており, 多施設後方視的研究においても同様に良好な結果が確認された. 特に, 横-S状静脈洞部DAVFに対しては, 正常静脈還流に寄与する罹患静脈洞温存が担保され, Borden type Iの病変に対してはとりわけ有効な治療法とする報告もある. 出血性高流量シャント例や多発病変・再発症例といった"難治性" DAVFに対しては, 血管内治療や直達術との補完的組み合わせでSRSは有効な治療選択肢となり得るであろう.
頭蓋内硬膜動静脈瘻（intracranial dural arteriovenous fistulas：DAVF）は，硬膜動脈と静脈洞/脳静脈との異常なシャントを特徴とする疾患で，脳出血や非出血性神経障害を引き起こす可能性がある．主たる治療法には血管内治療や直達術があり，近年は定位放射線手術（stereotactic radiosurgery：SRS）の有効性が報告されている．本総説はDAVFに対するSRSの最新のエビデンスをレビューし，その有効性と安全性を検証することを目的とした．SRSは高精度の局所放射線治療法である．SRSによるDAVFの5年累積完全閉塞率は67-89％と報告され，合併症はまれ（0-3％）であった．治療効果の予測因子としては，皮質静脈逆流の有無や病変局在が関連しており，多施設後方視的研究においても同様に良好な結果が確認された．特に，横-S状静脈洞部DAVFに対しては，正常静脈還流に寄与する罹患静脈洞温存が担保され，Borden type Iの病変に対してはとりわけ有効な治療法とする報告もある．出血性高流量シャント例や多発病変・再発症例といった“難治性”DAVFに対しては，血管内治療や直達術との補完的組み合わせで SRS は有効な治療選択肢となり得るであろう．
Author 長谷川, 洋敬
小泉, 聡
梅川, 元之
齊藤, 延人
新谷, 祐貴
片野, 厚人
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References_xml – reference: 15) Houser OW, Baker HL Jr, Rhoton AL Jr, et al : Intracranial dural arteriovenous malformations. Radiology 105: 55-64, 1972
– reference: 27) Newton TH, Cronqvist S : Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 93: 1071-1078, 1969
– reference: 10) Goto K, Sidipratomo P, Ogata N, et al : Combining endovascular and neurosurgical treatments of high-risk dural arteriovenous fistulas in the lateral sinus and the confluence of the sinuses. J Neurosurg 90: 289-299, 1999
– reference: 26) Murai S, Hiramatsu M, Suzuki E, et al : Trends in incidence of intracranial and spinal arteriovenous shunts: hospital-based surveillance in Okayama, Japan. Stroke 52: 1455-1459, 2021
– reference: 5) 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: 25) Mohammed N, Hung YC, Xu Z, et al : A propensity scorematched cohort analysis of outcomes after stereotactic radiosurgery in older versus younger patients with dural arteriovenous fistula: an international multicenter study. World Neurosurg 125: e1114-1124, 2019
– reference: 46) Yang HC, Kano H, Kondziolka D, et al : Stereotactic radiosurgery with or without embolization for intracranial dural arteriovenous fistulas. Neurosurgery 67: 1276-1285, 2010
– reference: 30) Pan DH, Chung WY, Guo WY, et al : Stereotactic radiosurgery for the treatment of dural arteriovenous fistulas involving the transverse-sigmoid sinus. J Neurosurg 96: 823-829, 2002
– reference: 20) Kiyosue H, Tanoue S, Okahara M, et al : Angioarchitecture of transverse-sigmoid sinus dural arteriovenous fistulas: evaluation of shunted pouches by multiplanar reformatted images of rotational angiography. AJNR Am J Neuroradiol 34: 1612-1620, 2013
– reference: 17) Hu YS, Wu CA, Lee CC, et al : Letter to the Editor. Sinus occlusion after SRS for transverse-sigmoid sinus dural arteriovenous fistulas. Neurosurg Focus 57: E18, 2024
– reference: 23) Lewis AI, Tomsick TA, Tew JM Jr : Management of tentorial dural arteriovenous malformations: transarterial embolization combined with stereotactic radiation or surgery. J Neurosurg 81: 851-859, 1994
– reference: 31) Park SH, Park KS, Kang DH, et al : Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: its clinical and angiographic perspectives. Acta Neurochir（Wien）159: 1093-1103, 2017
– reference: 21) Lalwani AK, Dowd CF, Halbach VV : Grading venous restrictive disease in patients with dural arteriovenous fistulas of the transverse/sigmoid sinus. J Neurosurg 79: 11-15, 1993
– reference: 2) Baek HG, Park SH, Park KS, et al : Stereotactic radiosurgery for dural arteriovenous fistulas involving the transverse-sigmoid sinus: a single center experience and review of the literatures. J Korean Neurosurg Soc 62: 458-466, 2019
– reference: 11) Gross BA, Ropper AE, Popp AJ, et al : Stereotactic radiosurgery for cerebral dural arteriovenous fistulas. Neurosurg Focus 32: E18, 2012
– reference: 45) Vollherbst DF, Ulfert C, Neuberger U, et al : Endovascular treatment of dural arteriovenous fistulas using transarterial liquid embolization in combination with transvenous balloon-assisted protection of the venous sinus. AJNR Am J Neuroradiol 39: 1296-1302, 2018
– reference: 32) Peters PA, Naylor RM, Lanzino G, et al : Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: patient outcomes and lessons learned over a 3-decade single-center experience. J Neurosurg, 2024 [Published online August 30, 2024]
– reference: 44) Umekawa M, Shinya Y, Hasegawa H, et al : Role of stereotactic radiosurgery in treatment for intracranial dural arteriovenous fistulas: advantages of three-dimensional rotational angiography-based planning. Surg Cereb Stroke 52: 195-202, 2024
– reference: 29) Oh JT, Chung SY, Lanzino G, et al : Intracranial dural arteriovenous fistulas: clinical characteristics and management based on location and hemodynamics. J Cerebrovasc Endovasc Neurosurg 14: 192-202, 2012
– reference: 16) Hu YS, Lin CJ, Wu CA, et al : Outflow patency correlates with radiosurgical outcomes of lateral sinus dural arteriovenous fistula. World Neurosurg 167: e397-405, 2022
– reference: 40) Söderman M, Dodoo E, Karlsson B : Dural arteriovenous fistulas and the role of gamma knife stereotactic radiosurgery: the Stockholm experience. Prog Neurol Surg 27: 205-217, 2013
– reference: 8) 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: 12) Hanakita S, Koga T, Shin M, et al : Role of Gamma Knife surgery in the treatment of intracranial dural arteriovenous fistulas. J Neurosurg 117（Suppl）: 158-116, 2012
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Snippet 頭蓋内硬膜動静脈瘻（intracranial dural arteriovenous fistulas：DAVF）は，硬膜動脈と静脈洞/脳静脈との異常なシャントを特徴とする疾患で，脳出血や非出血性神経障害を引き起こす可能性がある．主たる治療法には血管内治療や直達術があり，近年は定位放射線手術（stereotactic...
頭蓋内硬膜動静脈瘻(intracranial dural arteriovenous fistulas:DAVF)は, 硬膜動脈と静脈洞/脳静脈との異常なシャントを特徴とする疾患で, 脳出血や非出血性神経障害を引き起こす可能性がある. 主たる治療法には血管内治療や直達術があり,...
SourceID medicalonline
jstage
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StartPage 1
SubjectTerms cortical venous reflux
dural arteriovenous fistulas
sinus patency
stereotactic radiosurgery
Title 硬膜動静脈瘻に対する定位放射線手術の最前線 ─有効性・安全性の最新レビューと難治例への挑戦
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http://mol.medicalonline.jp/en/journal/download?GoodsID=cp4strok/2025/005301/001&name=0001-0005j
Volume 53
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ispartofPNX 脳卒中の外科, 2025, Vol.53(1), pp.1-5
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