Neurological Surgery 脳神経外科43巻5号

2015年05月発行

連載 脳卒中専門医に必要な基本的知識

（10）脳動静脈奇形に対する治療方針

著者： 中澤拓也¹ 横井俊浩¹ 辻篤司¹ 野崎和彦¹

所属機関： ¹滋賀医科大学脳神経外科学講座

ページ範囲：P.465 - P.473

Ⅰ．はじめに
　脳動静脈奇形はナイダスと呼ばれる動脈，静脈とはっきりと区別できず，毛細血管床をもたない異常血管の複雑に絡み合った塊で構成される．脳血管撮影では，動脈から静脈に直接短絡する血流が特徴的である．流入動脈から流出静脈に速い血流が流れることによってときに破裂を起こして，頭蓋内出血となり，これが最も重篤な脳動静脈奇形の合併症となる．脳動静脈奇形が破裂して頭蓋内出血を来しても比較的良好な経過をとることが多いが，破裂によるmorbidity, mortalityは無視できるほどのものでもない．多くは若年成人で発見され，遺伝的背景と環境因子の両方が関わるとの考えもある．また，ナイダス内に脳実質が介在するものがあり，cerebral proliferative angiopathyの概念も提唱されている²⁵⁾．
　治療については，その自然歴を考えると出血発症例と未破裂脳動静脈奇形でまず治療方針に違いが出てくるが，その大きさや場所などによっても変わってくる．自然歴もほとんどのデータが単一施設のcase seriesに限られており，まだまだ不明な点も多い．また，個々の症例によってリスクが異なり，その治療法も外科的摘出から血管内治療，定位放射線治療，それらの複合治療まで多岐にわたり，それぞれの特徴をもつ．これらのことを十分理解し，治療適応の決定を行う必要がある．

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