Kuroda Satoshi
Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama.
No Shinkei Geka. 2022 Jul;50(4):806-818. doi: 10.11477/mf.1436204624.
In this review article, the author describes the eligible patients, concept, surgical technique, and long-term outcome of the superficial temporal artery to middle cerebral artery(STA-MCA)anastomosis and the ultimate indirect bypass, called encephalo-duro-myo-arterio-pericranial synangiosis(EDMAPS)for adult moyamoya disease, in addition to the novel diagnostic criteria. The procedure dramatically improves or normalizes the cerebral blood flow immediately after surgery and thus contributes to preventing ischemic complications during and after surgery. However, the arterial wall of these patients is extremely thin and fragile; therefore, the surgeons should be trained extensively and have absolute confidence in their ability to perform this procedure. The surgeons should be aware that STA-MCA anastomosis frequently induces the hyper-perfusion phenomenon in adult patients with moyamoya due to prolonged cerebral ischemia. The extent of craniotomy determines the amount of surgical collaterals after indirect surgery; thus, a wide craniotomy including most of the frontal area, especially the medial frontal area, is critical to improve the postoperative prognosis. This procedure can markedly diminish the dangerous periventricular collateral channels and provides excellent long-term outcomes for up to 20 years after surgery. Long-term follow-ups longer than 20 years are important to monitor the patients with this unique and peculiar disease.
在这篇综述文章中，作者描述了成人烟雾病患者颞浅动脉-大脑中动脉（STA-MCA）吻合术以及最终的间接搭桥术（即脑-硬脑膜-肌肉-动脉-颅骨膜联合血管搭桥术，EDMAPS）的符合条件的患者、概念、手术技术、长期预后，以及新的诊断标准。该手术能在术后立即显著改善或使脑血流正常化，从而有助于预防手术期间及术后的缺血性并发症。然而，这些患者的动脉壁极其薄且脆弱；因此，外科医生应接受广泛培训，并对自己实施该手术的能力有绝对信心。外科医生应意识到，由于长期脑缺血，STA-MCA吻合术在成年烟雾病患者中常引发高灌注现象。开颅范围决定间接手术后手术侧支循环的数量；因此，包括大部分额叶区域，尤其是额叶内侧区域的广泛开颅对于改善术后预后至关重要。该手术可显著减少危险的脑室周围侧支通道，并在术后长达20年的时间里提供良好的长期预后。超过20年的长期随访对于监测患有这种独特疾病的患者很重要。
