Saito Atsushi, Takahashi Noboru, Furuno Yuichi, Kamiyama Hironaga, Nishimura Shinjitsu, Midorikawa Hiroshi, Nishijima Michiharu
Department of Neurosurgery, Aomori Prefectural Central Hospital, Aomori.
Neurol Med Chir (Tokyo). 2008 Oct;48(10):455-9. doi: 10.2176/nmc.48.455.
A 55-year-old man presented with a rare case of multiple isolated sinus dural arteriovenous fistulas (AVFs) associated with antithrombin (AT) III deficiency manifesting as sudden onset of headache and gait disturbance. Increased arterial shunting flow had caused intraventricular hemorrhage after incomplete repeated transarterial embolization procedures for dural AVFs. Multiple isolated sinus dural AVFs were located in the anterior superior sagittal sinus (SSS) and transverse sinus, which were completely embolized by direct packing of the isolated sinuses via the SSS. The development of dural AVF is complicated and associated with a number of factors, such as congenital abnormality, head trauma, craniotomy, radiation, hematological abnormality, and sinus thrombosis. Hematological abnormality is a risk factor of sinus thrombosis. In the present case, the multiple isolated sinus dural AVFs might have resulted from the aggravation of multiple dural AVFs and the coagulative tendency due to AT III deficiency. Direct sinus packing should be considered if transvenous catheterization is difficult or fails.
一名55岁男性，因罕见的多发孤立性窦硬膜动静脉瘘（AVF）合并抗凝血酶（AT）III缺乏症就诊，表现为突发头痛和步态障碍。在对硬膜动静脉瘘进行不完全重复经动脉栓塞术后，动脉分流增加导致脑室内出血。多发孤立性窦硬膜动静脉瘘位于上矢状窦（SSS）前部和横窦，通过经上矢状窦对孤立窦进行直接填塞完全栓塞。硬膜动静脉瘘的发生较为复杂，与多种因素有关，如先天性异常、头部外伤、开颅手术、放疗、血液学异常和窦血栓形成。血液学异常是窦血栓形成的危险因素。在本病例中，多发孤立性窦硬膜动静脉瘘可能是由于多个硬膜动静脉瘘加重以及AT III缺乏导致的凝血倾向所致。如果经静脉导管插入术困难或失败，应考虑直接窦填塞。
