臨床整形外科59巻7号

2024年07月発行

境界領域/知っておきたい

脊髄硬膜動静脈瘻

著者： 遠藤俊毅¹ 高橋義晴¹ 西澤威人¹ 佐々木達也¹

所属機関： ¹東北医科薬科大学脳神経外科

ページ範囲：P.956 - P.962

はじめに

　脊髄動静脈奇形は，脊髄あるいはその周辺に動静脈短絡(瘻孔)を有する疾患群の総称であり，短絡が存在する部位あるいは病態により分類される¹⁾．本稿では，このうち，日常臨床で遭遇する機会の最も多い脊髄硬膜動静脈瘻(dural arteriovenous fistula：dural AVF)について，実際の症例を提示し，その診断と治療のポイントを解説する．

参考文献

1) Endo T, Endo H, Sato K, et al. Surgical and endovascular treatment for spinal arteriovenous malformations. Neurol Med Chir (Tokyo) 2016;56(8):457-64.

2) Hiramatsu M, Ishibashi R, Suzuki E, et al. Incidence and clinical characteristics of spinal arteriovenous shunts:hospital-based surveillance in Okayama, Japan. J Neurosurg Spine 2022;36(4):670-7.

3) Takai K, Endo T, Yasuhara T, et al. Microsurgical versus endovascular treatment of spinal epidural arteriovenous fistulas with intradural venous drainage:a multicenter study of 81 patients. J Neurosurg Spine 2020;33(3):381-91.

4) Kiyosue H, Matsumaru Y, Niimi Y, et al. Angiographic and clinical characteristics of thoracolumbar spinal epidural and dural arteriovenous fistulas. Stroke 2017;48(12):3215-22.

5) Takai K, Endo T, Seki T, et al;Neurospinal Society of Japan CCJ AVF Study Investigators. Neurosurgical versus endovascular treatment of craniocervical junction arteriovenous fistulas:a multicenter cohort study of 97 patients. J Neurosurg 2021;137(2):373-80.

6) Kai Y, Hamada J, Morioka M, et al. Arteriovenous fistulas at the cervicomedullary junction presenting with subarachnoid hemorrhage:six case reports with special reference to the angiographic pattern of venous drainage. AJNR Am J Neuroradiol 2005;26(8):1949-54.

7) Hiramatsu M, Sugiu K, Ishiguro T, et al. Angioarchitecture of arteriovenous fistulas at the craniocervical junction:a multicenter cohort study of 54 patients. J Neurosurg 2018;128(6):1839-49.

8) 遠藤俊毅，冨永悌二．解剖を中心とした脳神経手術手技—脊髄動静脈奇形病変に対する外科治療．脳神経外科2021；49(3)：665-76．

9) Haryu S, Endo T, Sato K, et al. Cognard type V intracranial dural arteriovenous shunt:case reports and literature review with special consideration of the pattern of spinal venous drainage. Neurosurgery 2014;74(1):E135-42. doi:10.1227/NEU.0000000000000069.

10) Yamaguchi S, Takemoto K, Takeda M, et al. The Position and role of four-dimensional computed tomography angiography in the diagnosis and treatment of spinal arteriovenous fistulas. World Neurosurg 2017;103:611-9.

11) Endo T, Shimizu H, Sato K, et al. Cervical perimedullary arteriovenous shunts:a study of 22 consecutive cases with a focus on angioarchitecture and surgical approaches. Neurosurgery 2014;75(3):238-49;discussion 249.

12) Mansour A, Endo T, Inoue T, et al. Clipping of an anterior spinal artery aneurysm using an endoscopic fluorescence imaging system for craniocervical junction epidural arteriovenous fistula:technical note. J Neurosurg Spine 2019;31(2):279-84.

13) Takai K, Endo T, Yasuhara T, et al. Neurosurgical versus endovascular treatment of spinal dural arteriovenous fistulas:a multicenter study of 195 patients. J Neurosurg Spine 2020;34(3):514-21.