高等蓋窩硬膜動静脈奇形の病態生理と治療

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Dural arteriovenous malformation (dural AVM) of the posterior fossa is relatively rare and offers various problems concerning its pathophysiology and treatment In this paper, these problems were discussed on the basis of our experiences with 5 cases and a review of the literature. In our cases, all patients complainted of tinnitus and that all noticed bruit on admission Angiographically the AVM was fed by multiple arteries in all the cases and the sigmoid sinus was occluded in one case. Cerebral hymodynamics was examined by Greitz's method as well as Xe-133 clearance method and were found normal in each case Operation was carried out on 2 cases The feeders from the occipital artery were ligated extracranially and the AVM of the scalp was removed. In follow-up study (ranging from 9 months to 8 years and 5 months), tinnitus and bruit disappeared or decreased postoperatively in 2 cases and remained the same as on admission in the other 3 cases. Further signs or symptoms were not noticed. In dural AVM, clinical symptoms may occur as a result of several pathological conditions Tinnitus and head bruit are cause by arterio-venous shunt itself and more serious neurological deficits are produced by disturbance of cerebral hemodynamics due to massive arteriovenous shunt and accompaning secondary changes such as occlusion of the affected sinus, increase of venous pressure and retrograde flow of the cortical veins. But cerebral hypoxia or ischemia must not be produced by arteriovenous shunt which is usually rather minor in dural AVM. As for treatment, many kinds of operation have been carried out The most effective method has been the removal of dural AVM. However, the removal of AVM often presents extreme technical difficulties and may expose the patients to great hazard Therefore, for aged patinets with only tinnitus or bruit, extracranial ligation of feeders should be tried first.
日本脳神経外科学会の論文

高等蓋窩硬膜動静脈奇形の病態生理と治療

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