Kato Naoki, Kakizaki Shota, Hirokawa Yusuke, Michishita Shotaro, Ishii Takuya, Terao Tohru, Murayama Yuichi
Department of Neurosurgery, Atsugi City Hospital, 1-16-36, Mizuhiki, Atsugi, Kanagawa 243-8588, Japan.
Department of Neurosurgery, The Jikei University School of Medicine Tokyo, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan.
Case Rep Neurol Med. 2023 Jan 17;2023:1787738. doi: 10.1155/2023/1787738. eCollection 2023.
Moyamoya disease is often diagnosed after intracranial hemorrhage in adult patients. Here, we report a case of unilateral moyamoya disease treated with indirect revascularization combined with cranioplasty after treatment for acute subdural hematoma and subcortical hemorrhage. A middle-aged woman with disturbed consciousness was transferred to our hospital. Computed tomography (CT) revealed an acute subdural hematoma with left temporoparietal subcortical hemorrhage. Three-dimensional CT angiography indicated a scarcely enhanced left middle cerebral artery (MCA) that was suspected to be delayed or nonfilling due to increased intracranial pressure. Subsequently, hematoma evacuation and external decompression were performed. Postoperative digital subtraction angiography (DSA) revealed stenosis of the left MCA and moyamoya vessels, indicating unilateral moyamoya disease. Forty-five days after the initial procedure, we performed encephalo-arterio-synangiosis (EAS) using the superficial temporal artery simultaneously with cranioplasty for the skull defect. The modified Rankin Scale score of the patient one year after discharge was 1, and the repeat DSA showed good patency of the EAS. Revascularization using EAS in the second step can be an option for revascularization for hemorrhagic moyamoya disease if the patient required cranioplasty for postoperative skull defect after decompressive craniotomy.
烟雾病在成年患者中常于颅内出血后被诊断出来。在此，我们报告一例单侧烟雾病患者，在接受急性硬膜下血肿和皮质下出血治疗后，采用间接血管重建术联合颅骨成形术进行治疗。一名意识障碍的中年女性被转诊至我院。计算机断层扫描（CT）显示急性硬膜下血肿伴左侧颞顶叶皮质下出血。三维CT血管造影显示左侧大脑中动脉（MCA）强化极少，怀疑因颅内压升高导致延迟或未显影。随后，进行了血肿清除和外减压术。术后数字减影血管造影（DSA）显示左侧MCA狭窄及烟雾血管，提示单侧烟雾病。初次手术后45天，我们在颅骨缺损修补术的同时，使用颞浅动脉进行了脑动脉吻合术（EAS）。患者出院一年后的改良Rankin量表评分为1分，复查DSA显示EAS通畅良好。如果患者在减压性开颅术后因颅骨缺损需要进行颅骨成形术，第二步采用EAS进行血管重建可作为出血性烟雾病血管重建的一种选择。
