44歳男性,難聴の精査を受け,松果体部のAVMを指摘された.座位手術によるinfratentorial supracerebellar (ITSC) approachで外科的切除を行った.術中脳血管造影により全摘出を確認した.空気塞栓は心房内に流入する気泡を経食道エコーでモニターすることにより回避した.患者は神経学的な異常を認めず退院した.組織学的検討では,摘出標本には松果体に典型的な葉状配列を示す神経細胞を認めた.ITSC approachは,松果体部AVMの摘出において最も有効なアプローチの一つと考えられた.

We analyzed changes in cerebral hemodynamics due to reconstructive vascular surgery using positron emission tomography (PET) in 4 patients with severe internal carotid artery (ICA) stenosis and contralateral ICA occlusion. Three patients had carotid artery stenting (CAS), while the remaining had superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery. Preoperative cerebral blood flow (CBF) studies of all patients demonstrated various decreases in CBF in a resting state and cerebral vascular reactivity (CVR) to acetazolamide (ACZ) and an increase in the oxygen extraction fraction (OEF) on both sides. These parameters improved on both sides after CAS was performed. Our results indicate that CAS performed on a stenosis contralateral to the site of occlusion will improve cerebral hemodynamics bilaterally and indirectly, patient prognosis. But further clinical trials are required to determine whether CAS significantly reduces in stroke above the occlusion.