術前塞栓術と直達術により治療を行ったくも膜下出血発症の成人・後頭蓋窩pial AVFの1例

抄録

The incidence of pial arteriovenous fistulas (pAVFs) is low, and most cases are treated by interrupting the shunt via endovascular or direct surgery. In the present report, we describe a very rare case of pAVF and discuss the treatment and pathological findings of such cases in the literature. A 63-year-old woman presented with a sudden headache and vomiting. Computed tomography (CT) indicated the presence of a subarachnoid hemorrhage, but she was treated conservatively. The hematoma size gradually decreased and her neurological findings remained unchanged. Angiography indicated the presence of pAVF. The fistula was fed by small branches of the common trunk between the right anterior inferior cerebellar artery and posterior inferior cerebellar artery, and drained into the varix. Feeder occlusion was performed through Histoacryl infusion under local anesthesia. One day after embolization, the patient underwent right suboccipital craniotomy, and the pAVF was extirpated by electrocoagulation. Postoperative angiography indicated that the fistula had disappeared. She was discharged without any new neurological deficits. Thus, pAVF was treated in a more safe and reliable manner with combined therapy as compared to one-staged therapy.