頭蓋外arterio-venous malformation (AVM) に対するintravascular surgery

Abstract

We performed intravascular surgery on an extracranial AVM. Case 1: A 45-year-old female complained of a pulsatile tumor behind the left ear and of cosmetic problems, finding it hazardous to use a comb. Superselective angiography performed through the left occipital artery revealed a nidus (4×5cm) and drainers. Soon after, embolization with PVA (polyvinyl alcohol foam) was carried out and postoperative angiography showed the tumor to have disappeared. Three months later, a small tumor on the surface of the skin was resected. Pathohistological findings showed it to be a glomus tumor. Case 2: A 20-year-old male had suffered from a facial tumor since he was two years old. He had undergone coagulated ligation of the left common carotid artery and right peripheral facial artery. There was improvement of the tumor after this procedure, but it became enlarged about two years before admission to our hospital. A left VAG showed the muscle branch of the left vertebral artery communicating with the branch of the left external carotid artery, these vessels being the main suppliers of the tumor. Embolization (IBCA) was performed by direct puncture of the feeding arteries. A high quality angiography machine, the portable DSA (Diasonics) was used. The AVM has shown improvement but we intend to carry out further embolization. Embolization is now crucial in therapeutic angiography, and knowledge of its beneficial effects can help in the selection of appropriate cases. Skill, technique and excellent angiographical instruments are required. Embolization can in itself be a treatment or part of an over-all plan of therapy. One patient obtained a complete cure, while the other requires further embolization. It is our opinion that intravascular surgery is the first choice for treatment of extracranial AVM.