25. 摘出困難なAVMに対するcyanoacrylate monomerによるembolization

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概要

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• A right parasagittal AVM involving the posterior frontal and parietal lobes was treated by embolization with cyanoacrylate monomer (Aron alpha A). Angiograms revealed successful obliteration of the lesion with a small residual tuft in the two and a half years follow-up period. The present paper described the intraoperative embolization techniques and resultant sequential changes of the malformation.<BR>Case: A 36-year-old housewife was admitted in September, 1981 with a history of generalized convulsion and frequent episodes of the left face and upper trunk numbness of five years duration. No definite abnormalities were disclosed on neurological examination. Right carotid angiograms demonstrated AVM approximately 6 cm in diameter fed by the precentral and central arteries of the right middle cerebral artery and the callosomarginal and pericallosal arteries of the anterior cerebral artery and drained into the superior sagittal sinus. A right frontoparietal craniotomy was performed, and 1.0 ml of cyanoacrylate monomer loaded in a tuberculin syringe with a 26 gauge needle was injected into both the malformation and dilated precentral artery. Three injections in the AVM itself and one in the precentral artery were performed. A clip was also placed on the right central artery immediately proximal to the AVM.<BR>Further intravascular embolization was not attempted in the feeding branches of the right anterior cerebral artery. On immediate postoperative right carotid angiograms, the AVM was not opacified via branches of the right middle cerebral artery, but small residual malformation filled via the pericallosal artery of the anterior cerebral artery.<BR>Angiograms obtained two and a half years after the surgical procedure disclosed further reduction in size of opacification, and the process of obstruction in the AVM after intravascular embolization was estimated to be in progress.

著者

• 後藤 恒夫

  平鹿総合病院第二内科

• 平山 章彦

  平鹿総合病院 脳神経外科

• 小島 寿志

  平鹿総合病院脳神経外科

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