[症例報告]左レンズ核線状体動脈から発生した動静脈奇形,動脈瘤合併の1手術例

概要

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A case of arteriovenous malformation combined with an aneurysm in the left basal ganglia is presented. A 38-year-old male patient was admitted in our hospital because of right hemiparesis and aphasia. He had history of left putaminal hemorrhage six months prior to the admission, and had since been treated conservatively. Left carotid angiogram demonstrated an AVM combined with an aneurysm, both arising from one of the medial lenticulostriate arteries. In order to prevent rebleeding, both lesions were surgically operated. The nidus of AVM was electrically coagulated, and the aneurysm was resected at the neck. Histological examination revealed that the intima of aneurysm was hypertrophic associated with hyaline degeneration. The internal elastic lamina was fragmented, and the smooth muscles of the media disappeared and were displaced by fibrosis. Postoperative angiogram showed no abnormal vessels any more. It is suggested that increased blood flow might be the main factor to develop an aneurysm in such an AVM case. The hazard of rebleeding from such lesions is to indicate, in case possible, radical treatment of both lesions.