福井 仁士

Diamox負荷99mTc-HMPAO SPECTを用いたモヤモヤ病の脳循環の評価

Diamox負荷99mTc-HMPAO SPECTを用いてモヤモヤ病患者の脳循環を評価した。対象はモヤモヤ病9例 (小児4例, 成人5例) である。安静時では9例中6例に血流低下を認めた。3例では血流低下を認めなかった。Diamoxテストは9例中6例で陽性であったが, 安静時に異常がみられなかった3例はすべて陽性であった。以上より, Diamox負荷99mTc-HMPAO SPECTはモヤモヤ病患者の脳循環の評価に有用であった。

Vascular sacを伴い, クモ膜下出血にて発症した頭蓋底部硬膜動静脈奇形の2症例

Two cases of dural arteriovenous malformation (dAVM) with a vascular sac at the dilated pial vein as a drainer are reported in this paper. The dAVM were located at the anterior cranial fossa in Case 1 and at the petrous portion in Case 2. Both cases had intracranial hemorrhage and, especially in Case 1, the associated vascular sac was thought to be the source of the hemorrhage, for its location was the same as the small intracerebral hematoma. The relationship between the intracranial hemorrhage and cortical drainage are discussed in the paper. The importance of blockade of cortical drainage and occlusion or removal of nidus is stressed for protection against intracranial hemorrhage.

AVM摘出後normal perfusion pressure breakthroughを呈し, barbiturate療法が奏効した1例

Massive cerebral swelling with multifocal bleeding rarely occurs after a technically successful removal of cerebral arteriovenous malformation (AVM). When manifested, this frightening complication is hardly manageable. The phenomenon, termed normal, perfusion pressure breakthrough by Spetzler and Wilson, is thought to be due to a rapid diversion of the blood flow from the AVM into the adjacent, chronically dilated, non-autoregulating small blood vessels. We recently experienced a case of large patieto-occipital AVM that exhibited multifocal massive bleeding immediately after an apparently successful total removal under the surgical microscope. High-dose barbiturate administration was then initiated during surgery and was maintained for 63 hours postoperatively. Controlled hyperventilation, and steroid and osmotic dehydrating therapy were also employed to control elevation of the intracranial pressure. The patient showed a good recovery and returned home without neurological deficits except for incomplete homonymous hemianopia. As already reported by others, this protocol seems effective for the management of the nightmarish, hardly controllable cerebral swelling with bleeding that may occur as a consequence of AVM removal.