Yoshioka N, Tominaga S
Department of Plastic and Reconstructive Surgery, Osaka City University Medical School.
Neurol Med Chir (Tokyo). 1998 Aug;38(8):464-8; discussion 467-8. doi: 10.2176/nmc.38.464.
The efficacy of encephalo-myo-synangiosis (EMS) using muscle free flap was evaluated for the treatment of ischemic cerebrovascular disease in adult patients. Three patients with adult moyamoya disease and three patients with atherosclerotic ischemic cerebrovascular disease were treated. EMS used four latissimus dorsi muscles and two serratus anterior muscles. Postoperative selective angiography showed collateral circulation from the transferred muscle to the brain in four of the six patients. The other two patients showed patent nutrient artery of the transferred muscle flap. Cerebral blood flow study disclosed postoperative improvement of perfusion reserve capacity in all sides. One patient suffered a perioperative stroke by hemoconcentration due to poor control of diabetes mellitus. The mean follow-up period was 23 months. EMS using muscle free flap is a possible procedure in selected patients with impaired cerebral perfusion reserve capacity due to multiple stenosis or occlusion of cerebral arteries including moyamoya disease or who required cerebral blood flow augmentation in the anterior and/or posterior cerebral artery territories due to internal carotid artery occlusion.
评估了使用游离肌瓣的脑-肌-血管吻合术（EMS）治疗成年患者缺血性脑血管疾病的疗效。治疗了3例成年烟雾病患者和3例动脉粥样硬化性缺血性脑血管疾病患者。EMS使用了四块背阔肌和两块前锯肌。术后选择性血管造影显示，6例患者中有4例出现了从转移肌瓣到脑的侧支循环。另外2例患者转移肌瓣的滋养动脉通畅。脑血流研究显示，各侧的灌注储备能力术后均有改善。1例患者因糖尿病控制不佳导致血液浓缩，在围手术期发生中风。平均随访期为23个月。对于因包括烟雾病在内的脑动脉多处狭窄或闭塞导致脑灌注储备能力受损，或因颈内动脉闭塞而需要增加大脑前动脉和/或大脑后动脉区域脑血流量的特定患者，使用游离肌瓣的EMS是一种可行的手术方法。
