BRAIN and NERVE－神経研究の進歩60巻8号

2008年08月発行

特集 脳硬膜動静脈瘻

脳硬膜動静脈瘻の分類と診断

著者： 桑山直也¹²

所属機関： ¹富山大学医学部脳神経外科 ²富山大学医学部脳血管内治療科

ページ範囲：P.887 - P.895

文献概要

Ⅰ．硬膜動静脈瘻の分類

　頭蓋内硬膜動静脈瘻は次のような部位に発生する；海綿静脈洞，横-S状静脈洞，上矢状静脈洞，静脈洞交会，前頭蓋底，下錐体静脈洞，上錐体静脈洞（またはテント外側型），直静脈洞（またはテント正中型），テント，頭蓋頸椎移行部，脳表静脈（頭蓋円蓋部や小脳表面），脳底静脈叢，蝶形頭頂静脈洞，辺縁静脈洞，anterior condylar confluence。

　本疾患には発生部位による分けかた以外に，以下のようにさまざまな分類法が提唱されている。中でも静脈還流形態による分類法（Cognard，Borden，Lalwani分類）は症候学，治療適応，治療方法に直接結びつくものであり，血行動態を理解し，治療法を選択するうえで最も重要な分類法といえる。いずれも「静脈洞閉塞の有無」，「シャントの還流方向が順行性か逆行性か」，「正常脳静脈還流が障害されているか否か」が要点である。

参考文献

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