脳神経外科速報

今回のグレードアップを機に，「私の手術論」シリーズを「私の手術戦略」として再構成することになりました．実際の症例を取り上げ，エキスパートの戦略の核心をお聞きします．

脳動脈瘤手術の手技は確立された感があるが，その術式には施設・術者間で大きな違いがある．脳神経外科の手術教育を考えた場合，鋭的剥離を基本とする脳動脈瘤手術をある程度定型的なかたちで繰り返すことはマイクロサージェリーの格好のトレーニングになると考えている．しかし一方で，時に思わぬトラブルやアクシデントが引き起こされる可能性もあり，細心の注意を求められる手術でもある．脳動脈瘤手術のコツとピットフォールについて私見を述べる．今回は，開閉頭と手術器械をテーマとする．

(Background) The use of gamma knife radiosurgery (GK) for the treatment of trigeminal neuralgia has increased in recent years. However, refractory trigeminal neuralgia after GK is reported in approximately 30percent of cases of GK-treated trigeminal neura

We presented a case of vertebral arteriovenous fistula associated with neurofibromatosis Type 1(NF1). A 31-year-old man was referred to our hospital because of monoparesis and hypesthesia of left upper extremity and neck pain. He was given a diagnosis of NF1 because of neurofibroma and cafe-au-lait spot. A cervical CT scan at the level of C6 showed an enhanced mass anterior to the left transverse process. Angiography revealed aneurysmal dilatation of the left vertebral artery and an arteriovenous fistula draining into the vertebral venous plexus. We thought that aneurysmal dilatation and arteriovenous fistula in this case of NF1 might be caused by the fragility of the arterial wall because of mesodermal abnormality. Occlusion of left vertebral artery using coils resulted in successful obliteration of the arteriovenous fistula. The patient's clinical condition improved significantly. Embolization using coils was effective for vertebral arteriovenous fistula associated with NF1. Key Words: arteriovenous fistula, neurofibromatosis type 1, vertebral artery, embolization