硬膜動静脈瘻に対する外科的治療成績とそのｐｉｔｆａｌｌ

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We present the results and pitfalls of surgery for dural arteriovenous fistula (dAVF). Between 1976 and 2007, we treated 257 patients with dAVF. Among them, 19 (13 men, 6 women) underwent direct surgery including drainer ligation and sinus resection. Their ages ranged from 48 to 82 years (mean 62 years). Of 19 dAVFs, 10 were located in the anterior fossa (AF) dural arteriovenous fistula, 1 in the cavernous sinus (CS), 5 were tentorial (T) and 3 were transverse-sigmoid sinus (TS) dAVF. The 3 patients with TS dAVF underwent resection of an isolated sinus, and the other 16 were treated by ligation of the draining vein; in 9 of these, transarterial embolization was subsequently performed. In 18 patients (95%), there was postoperative confirmation of shunt obliteration. After direct surgery, 2 patients with T dAVF suffered cerebral hemorrhage. In 1, T dAVF retrograde flow to petrosal veins occurred after clipping of the draining vein. In 14 patients, the outcome was good, 2 each were moderately or severly disabled and 1 patient survived in a vegetative state. Although dAVF surgery is an effective treatment, attention must be paid to cerebral hemorrhage and the development of a new draining vein in patients with T dAVF.
一般社団法人日本脳卒中の外科学会の論文