脳動静脈奇形の微小血管構築

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Thirty patients with cerebral AVM (19 men and 11 women; 0-82 years old) underwent superselective angiography to evaluate the microvascular architecture before endovascular or surgical treatment. Of these 30 patients, 20 presented with intracranial hemorrhage and 10 with others. The nidus was located in the cerebral cortex in 20 patients, the cerebral subcortex in 7 and the cerebellum in 3. The nidus was classified into 3 types with superselective angiography: (1) type-RD nidus, which consisted of reticular and dense vessels, (2) type-RS consisted of reticular and scattered vessels, (3) type-F consisted of fistulous vessels. Twenty-four patients had a type-RD nidus, 1 had a combined type-RD and RS, 5 had a combined type-RD and F, and 1 had a pure type-F nidus. In 1 patient, the nidus seemed to be type-RD on the conventional angiogram, but superselective angiography revealed it to be a fistulous single cavity. As other findings, 6 venous varices on the draining route, 2 separated nidi connected with venous bridges, and an arterialized venous malformation were clarified with superselective angiography. Three transit arteries and 4 feeding perforating arteries were also detected. In 2 patients, the normal cortical artery distal to the nidus was reconstructed by the leptomeningeal collateral circulation in the retrograde fashion. In conclusion, superselective angiography provides new detailed information useful for both endovascular and surgical treatment.
日本脳卒中の外科学会の論文
2001-11-30

脳動静脈奇形の微小血管構築

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