Fujimura Miki, Kaneta Tomohiro, Shimizu Hiroaki, Tominaga Teiji
Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
Childs Nerv Syst. 2007 Oct;23(10):1195-8. doi: 10.1007/s00381-007-0361-2. Epub 2007 May 8.
Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). It is undetermined, however, how rapid increase in CBF affects ischemic brain at acute stage, especially in children.
A 4-year-old girl with moyamoya disease underwent right superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. She suffered temporary left facial palsy 5 days after surgery. Postoperative N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography (123I-IMP-SPECT) revealed focal intense increase in CBF at the sites of anastomosis. Magnetic resonance imaging/angiography showed the apparently patent STA-MCA anastomosis as a thick high signal without ischemic changes. Her symptom improved 9 days after surgery, and single-photon emission computed tomography (SPECT) 2 months later showed normalization of CBF. Surgical revascularization completely relieved the transient ischemic attack on her left hand that was seen before surgery.
We demonstrated, for the first time, that delayed focal neurological deficit after STA-MCA anastomosis can be caused by focal hyperperfusion in childhood moyamoya disease.
烟雾病的外科血管重建术通过改善脑血流量（CBF）来预防脑缺血发作。然而，CBF的快速增加在急性期对缺血性脑的影响尚不清楚，尤其是在儿童中。
一名4岁烟雾病女孩接受了右侧颞浅动脉-大脑中动脉（STA-MCA）吻合术。术后5天出现暂时性左侧面瘫。术后N-异丙基-p-[123I]碘安非他明单光子发射计算机断层扫描（123I-IMP-SPECT）显示吻合部位CBF局灶性强烈增加。磁共振成像/血管造影显示STA-MCA吻合术明显通畅，呈粗大高信号，无缺血改变。术后9天症状改善，2个月后单光子发射计算机断层扫描（SPECT）显示CBF恢复正常。外科血管重建术完全缓解了术前出现的左手短暂性缺血发作。
我们首次证明，儿童烟雾病患者在STA-MCA吻合术后出现的延迟性局灶性神经功能缺损可能是由局灶性高灌注引起的。
