Acquired Pial and Dural Arteriovenous Fistulae following Superior Sagittal Sinus Thrombosis in Patients with Protein S Deficiency: A Report of Two Cases
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- MATSUBARA Shunji
- Department of Neurosurgery, Institute of Health Biosciences, The University of Tokushima Graduate School
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- SATOH Koichi
- Department of Neurosurgery, Tokushima Red Cross Hospital
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- SATOMI Junichiro
- Department of Neurosurgery, Institute of Health Biosciences, The University of Tokushima Graduate School
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- SHIGEKIYO Toshio
- Department of Internal Medicine, Tokushima Prefectural Hospital
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- KINOUCHI Tomoya
- Department of Neurosurgery, Tokushima Red Cross Hospital
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- MIYAKE Hajimu
- Department of Neurosurgery, Tokushima Red Cross Hospital
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- NAGAHIRO Shinji
- Department of Neurosurgery, Institute of Health Biosciences, The University of Tokushima Graduate School
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Two patients with protein S deficiency with acquired multiple pial and dural arteriovenous fistulae (AVFs) following superior sagittal sinus (SSS) thrombosis are reported. Case 1 is a 38-year-old male with protein S deficiency who developed generalized seizure due to SSS thrombosis. Local fibrinolysis was achieved in the acute stage. His 10-month follow-up angiogram revealed an asymptomatic acquired dural AVF arising from the middle meningeal artery and the anterior cerebral artery with drainage to the thrombosed cortical vein in the right frontal lobe. Furthermore, his 2-year follow-up angiogram revealed a de novo pial AVF from the middle cerebral artery in the Sylvian fissure with drainage to the cortical vein initially thrombosed. However, this asymptomatic pial AVF caused bleeding in the ipsilateral cerebral hemisphere 12 years after onset, whereas the dural AVF spontaneously disappeared. Surgical disconnection was successfully performed to eliminate the source of hemorrhage. Case 2 is a 50-year-old male with a past history of SSS thrombosis with protein S deficiency who developed pulsatile tinnitus and generalized seizure. His angiogram showed a cortical dural AVF in the left parietal lobe and a sporadic dural AVF involving the right sigmoid sinus. The parietal lesion was eliminated by transarterial embolization followed by craniotomy. However, a de novo pial AVF emerged from the middle cerebral artery adjacent to the previously treated lesion. Of four cortical AVFs in two patients, thrombosis of cortical veins caused by protein S deficiency might play an important role in their formation. Long-term follow-up is required because this peculiar disorder has an unusual clinical course.
収録刊行物
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- Neurologia medico-chirurgica
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Neurologia medico-chirurgica 54 (3), 245-252, 2014
一般社団法人 日本脳神経外科学会