前頭蓋窩硬膜動静脈奇形 : 比較的若年時での破裂発作が疑われた1症例の報告と文献的考察

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The patient is a 52-year-old man referred with an episode of loss of consciousness. His medical history showed a similar episode 30 years ago, with bloody cerebrospinal fluid. However, the etiology of the subarachnoid hemorrhage was not then established. He had been in good health until he experienced the loss of consciousness in August, 1980. Neurological and physical examinations were normal. Contrast-enhanced computerized tomography demonstrated an irregular linear density in the right anterior cranial base. Angiography revealed an arteriovenous malformation (AVM) in the anterior cranial base, fed by the anterior and posterior ethmoidal arteries, and draining into the olfactory and uncal veins via a dilated vascular sac. The diagnosis of dural AVM was made. A right frontal craniotomy was performed. Many feeding vessels penetrating the anterior cranial base were identified and coagulated. The dilated vascular sac on and in the dura mater was totally removed en-bloc with draining veins. Histologically, the wall of the vascular sac was thickened and degenerated. There were no angiomatous components. The postoperative course was uneventful, and an angiography revealed complete disappearance of the AVM. Only 17 patients with dural AVM in the anterior fossa are found in the literature. Most of them are male, and all are over 40 years old (average: 54 years). The present case had a subarachnoid hemorrhage at the age of 23 years, which could have attributed to the rupture of the dural AVM found at the age of 52 years. The most remarkable characteristic of dural AVMs in this location is the frequent finding of a dilated vascular sac which often ruptures, thus resulting in intracranial hemorrhage.
日本脳神経外科学会の論文
1986-10-15

前頭蓋窩硬膜動静脈奇形 : 比較的若年時での破裂発作が疑われた1症例の報告と文献的考察

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