側脳室脈絡叢部のsmall vascular malformation : 臨床診断上の問題点について

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The authors presented four cases of small vascular malformation (SVM) of choroid plexus in the lateral ventricle and reviewed the 21 cases reported since 1950. Although 85% of the reported cases occurred in the first four decades of life, two of the authors' series were over 40 years old. The initial symptom was a subarachnoid hemorrhage in 85% of the reported cases and all cases in the authors' series. Focal neurological deficits were present in 33% of the reported cases and two of the authors' series. Diagnosis of the lesion was made antemortem in 16 of the reported 21 cases and all of the authors' series. Eight of the 16 cases were diagnosed by angiography, two by CT scan, five at the time of operative exploration for intracerebral hematoma or mass lesion in the lateral ventricle and one after plexectomy for hydrocephalus. Among the 15 reported cases with cerebral angiography, the feeding artery, nidus and draining vein were visualized in only seven cases. Case 1 and Case 2 of the authors' series showed similar angiographic findings. Histologically these SVMs were all arteriovenous malformations (AVM). However, only one of the six reported cases of SVM classified as either cavernous, or venous angioma or teleangiectasis revealed a small vascular arca of radiopaque material. In Case 3 of venous angioma, serial angiography showed a very small, spotted vascular lesion in the early arterial phase, and revealed a nearly homogeneous area of contrast material of small size in the venous phase. In Case 4 of cavernous angioma, both a small vascular lesion and early venous filling were demonstrated by serial angiography. CT scans revealed abnormal vascular lesions in two out of four reported cases of choroid plexus SVM in the lateral ventricle. It was possible to detect the precise anatomical location of the SVM, such as whether a lesion was confined to the choroid plexus or involved deep nuclei. CT scans were also valuable as shown in Case 4 for the identification of cavernous or venous angioma which sometimes did not show apparent angiographic findings. CT scans safely showed either the extent of the hematoma or the degree of hydrocephalus accompanying the SVM. In conclusion, the authors emphasize that in cases of subarachnoid hemorrhage with neither aneurysms nor macroangioma, the possibility of the presence of choroid plexus SVM in the lateral ventricle must be considered. A combination of serial and magnification angiography, the film subtraction technique and CT scanning is very useful and necessary in identifing this type of lesion.
日本脳神経外科学会の論文
1982-02-15

側脳室脈絡叢部のsmall vascular malformation : 臨床診断上の問題点について

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