Machida Toshio, Ono Junichi, Nomura Ryota, Fujikawa Atsushi, Nagano Osamu, Higuchi Yoshinori
Department of Neurosurgery, Chiba Cardiovascular Center.
Neurol Med Chir (Tokyo). 2014;54(10):827-31. doi: 10.2176/nmc.cr.2013-0261. Epub 2014 Mar 27.
Here we report a case of moyamoya disease in which cortical veins reddened after superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis, following postoperative hyperperfusion. A 37-year-old man with moyamoya disease suffered cerebral infarction in his right hemisphere. Single photon emission computed tomography (SPECT) showed impaired cerebral blood flow (CBF) in both cerebral hemispheres. The patient underwent STA-MCA anastomosis in the right cerebral hemisphere. During operation, soon after declamping the STA, cortical veins near the anastomosis site changed its color from blue to red. This change was repeatable by clamping and declamping of the STA. Postoperative SPECT and computed tomography (CT) demonstrated increased CBF and subarachnoid hemorrhage at the anastomosis site, suggesting the occurrence of postoperative hyperperfusion. By strictly controlling the patient's blood pressure, the syndrome resolved 1 week after the operation. We propose that the venous reddening after STA-MCA anastomosis may be a sign of postoperative hyperperfusion.
在此，我们报告一例烟雾病病例，该患者在颞浅动脉（STA）至大脑中动脉（MCA）吻合术后出现皮质静脉发红，继发于术后高灌注。一名患有烟雾病的37岁男性右半球发生脑梗死。单光子发射计算机断层扫描（SPECT）显示双侧大脑半球脑血流量（CBF）受损。该患者在右半球接受了STA-MCA吻合术。手术过程中，在松开STA夹闭后不久，吻合部位附近的皮质静脉颜色从蓝色变为红色。这种变化通过夹闭和松开STA可重复出现。术后SPECT和计算机断层扫描（CT）显示吻合部位CBF增加和蛛网膜下腔出血，提示术后高灌注的发生。通过严格控制患者血压，该综合征在术后1周得到缓解。我们认为STA-MCA吻合术后静脉发红可能是术后高灌注的一个征象。
