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| 概要 |
症例は44歳,男性.頭痛,嘔吐および左同名半盲で発症し,CT・MRlで右側頭葉に亜急性期の血腫を認めた.術前の脳血管撮影では,血管奇形の所見は認められなかった.術中の所見では,血腫壁に多数の血管がみられ,これらは白質を貫き脳室上衣下静脈に連続していた.これらの血管に血管平滑筋はみられたが,肉弾性板を欠き,静脈と判明した.以上より,髄質静脈奇形(medullary venous malformati...on; MVM)と診断した.本来MVMは放射線学的診断名であるが,脳血管撮影で描出できない静脈奇形は少なくなく,その診断には術中,血腫壁への流入・導出血管の観察と組織学的検索が必要であるが,摘出標本の実体顕微鏡による注意深い観察も有用であることを述べた.
Reported is a case of a 44-year-old man who developed an intracerebral hematoma of the right temporal lobe. Angiography failed to reveal any vascular abnonTlalities except for the presence of the mass. The hematoma was evacuated through a craniotomy, at which time many small vessels were noted in the surrounding white matter and the wall of the hematoma. These vessels connected to the subependymal veins of the inferior horn of the right lateral ventricle. Histologically, these vessels had smooth vascular muscles without internal elastic laminae, indicating venous channels. Thus, based on these finclings, the vascular lesion was diagnosed as being a medullary venous ma]forma-tion. In the diagnosis of a medu]lary venous malformation, it must be kept in mind that angiography does not always visualize the radiological findings. Therefore, the importance of the operative findings and careful macro- and micro scopic examinations of the resected specimen are stressed.続きを見る
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