Ishii Keisuke, Morishige Masaki, Anan Mitsuhiro, Sugita Kenji, Abe Eiji, Kubo Takeshi, Fujiki Minoru, Kobayashi Hidenori
Department of Neurosurgery, Oita University School of Medicine, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan.
Acta Neurochir Suppl. 2010;107:95-9. doi: 10.1007/978-3-211-99373-6_15.
Various types of revascularization surgery have been performed for moyamoya disease. Although the efficacies of these operations are well recognized, the optimal operative procedure remains undecided. In this report, we describe our modified surgical revascularization procedure for moyamoya disease and retrospectively analyze the results of such surgeries on six sides in six adult patients.
Our operative procedure, combining direct and indirect bypasses, is a superficial temporal artery to middle cerebral artery anastomosis with encephalo-duro-myo-synangiosis. The encephalo-duro-myo-synangiosis is an indirect bypass combining the encephalo-duro- and encephalo-myo-synangioses. This operative procedure has been used routinely in adult patients since 2002.
Perioperative complications were noted in one of the six operations. This complication was transient and no attributive lesions were detected on CT or MRI. Revascularization was seen in cerebral blood flow studies in all patients, and the clinical outcomes were excellent or good. Effective neovascularization through the grafts was observed in all patients in follow-up angiographies.
This operative procedure provides needed revascularization and prevents ischemic deficits. This modified procedure is useful for responding to subsequent additional ischemia in the area of the anterior cerebral artery and should be considered one of the optimal procedures for treating moyamoya disease.
针对烟雾病已开展了各种类型的血运重建手术。尽管这些手术的疗效已得到充分认可，但最佳手术方式仍未确定。在本报告中，我们描述了我们改良的烟雾病手术血运重建方法，并回顾性分析了6例成年患者6侧此类手术的结果。
我们的手术方法是将直接和间接搭桥相结合，即颞浅动脉-大脑中动脉吻合术联合脑-硬膜-肌-联合血管吻合术。脑-硬膜-肌-联合血管吻合术是一种将脑-硬膜联合血管吻合术和脑-肌联合血管吻合术相结合的间接搭桥手术。自2002年以来，该手术方法已在成年患者中常规使用。
6例手术中有1例出现围手术期并发症。该并发症为一过性，CT或MRI未发现相关病变。所有患者的脑血流研究均显示有血运重建，临床结果为优或良。随访血管造影显示所有患者通过移植血管均实现了有效的新生血管形成。
该手术方法可实现所需的血运重建并预防缺血性神经功能缺损。这种改良方法有助于应对大脑前动脉区域随后出现的额外缺血情况，应被视为治疗烟雾病的最佳手术方法之一。
