Matsuoka Go, Aihara Yasuo, Yamaguchi Koji, Ishikawa Tatsuya, Kawashima Akitsugu, Kawamata Takakazu, Okada Yoshikazu
Department of Neurosurgery, Tokyo Women's Medical University Hospital, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan.
Childs Nerv Syst. 2015 Jul;31(7):1195-9. doi: 10.1007/s00381-015-2709-3. Epub 2015 Apr 23.
Surgical revascularization for pediatric moyamoya disease improves cerebral blood flow (CBF) and consequently may prevent further ischemic events. However, the timing of the treatment is controversial especially for patients with no ischemic symptom and normal CBF. The purpose of this case report is to inform and infer the surgical treatment timing for pediatric moyamoya disease patients.
A 10-year-old female patient with unilateral moyamoya disease complaining of only headache as a symptom and whose Suzuki stage was II or in transition to III by angiography and CBF was almost normal was admitted to Tokyo Women's Medical University Hospital. We performed superficial temporal artery-middle cerebral artery (STA-MCA) double anastomoses for the patient because we estimated her headache was derived from low perfusion in the brain. STA-MCA bypass surgery was not only effective for relief of her severe headache but also valid for her cerebral perfusion. Her angiography showed much supply from external carotid artery to intracranial arteries via bypass grafts in 7 months.
Our case showed early surgical treatment was beneficial for relief of severe headache even for early staged pediatric moyamoya disease patients by improving perfusion pressure and cerebral circulation.
小儿烟雾病的外科血管重建可改善脑血流量（CBF），从而可能预防进一步的缺血性事件。然而，治疗时机存在争议，尤其是对于没有缺血症状且脑血流量正常的患者。本病例报告的目的是为小儿烟雾病患者的外科治疗时机提供信息并进行推断。
一名10岁单侧烟雾病女性患者，仅主诉头痛，血管造影显示铃木分期为II期或向III期转变，脑血流量基本正常，入住东京女子医科大学医院。我们为该患者进行了颞浅动脉-大脑中动脉（STA-MCA）双吻合术，因为我们估计她的头痛源于脑部低灌注。STA-MCA搭桥手术不仅有效缓解了她的严重头痛，而且对她的脑灌注也有效。7个月后她的血管造影显示通过搭桥移植物颈外动脉向颅内动脉有大量供血。
我们的病例表明，即使对于早期小儿烟雾病患者，早期手术治疗通过改善灌注压力和脑循环，对缓解严重头痛也是有益的。
