Takeuchi S, Koike T, Tanaka R
Department of Neurosurgery, Niigata University, Japan.
Surg Neurol. 1997 Dec;48(6):615-9. doi: 10.1016/s0090-3019(97)00015-3.
Although there have been various interposed bypass grafts used for cerebral revascularization, the occipital artery has never been used as a graft. Interposed occipital artery bypass graft in an adult case with moyamoya disease after failed indirect revascularization is presented.
This 34-year-old woman with moyamoya disease, who had suffered from cerebral ischemic symptoms since the age of 6 years, was admitted to our hospital because of an intracerebral hemorrhage on the left side. She had undergone superficial temporal-to-middle cerebral artery anastomosis, encephalo-galeo-synangiosis on the right side, and encephalo-duro-arterio-synangiosis on the left side at age 29 years. Four months after the intracerebral hemorrhage, she still had cerebral ischemic symptoms in the left hemisphere where cerebral revascularization was poor. Since neither the superficial temporal nor occipital artery could be used for direct anastomosis because of spontaneous transdural anastomoses of the superficial temporal artery and the short length of the occipital artery, anastomosis between the left superficial temporal artery and left posterior parietal artery was performed using a left occipital artery graft 6 months after the hemorrhage. Postoperative external carotid angiograms showed good patency of the graft.
In cases in which direct anastomosis is infeasible for cerebral revascularization, the occipital artery could successfully be used as a bypass graft.
尽管已经有多种搭桥移植物用于脑血运重建，但枕动脉从未被用作移植物。本文报道了一例在间接血运重建失败后采用枕动脉搭桥移植物治疗烟雾病的成年病例。
该34岁烟雾病女性患者自6岁起出现脑缺血症状，因左侧脑出血入院。29岁时，她接受了颞浅动脉-大脑中动脉吻合术、右侧脑-帽状腱膜-联合血管吻合术以及左侧脑-硬膜-动脉-联合血管吻合术。脑出血4个月后，她左半球仍有脑缺血症状，且该部位脑血运重建较差。由于颞浅动脉自发经硬膜吻合以及枕动脉长度较短，颞浅动脉和枕动脉均无法用于直接吻合，因此在脑出血6个月后，采用左枕动脉移植物进行了左颞浅动脉与左顶后动脉之间的吻合。术后颈外动脉血管造影显示移植物通畅良好。
在脑血运重建无法进行直接吻合的病例中，枕动脉可成功用作搭桥移植物。
