当科のレジデント、加茂徹大先生の論文「原始嗅神経動脈〜もやもや病における前大脳動脈への新しい側副血行路」がJ Stroke Cerebro-vasc Dis誌に掲載されました。
今回の研究によって、約5％のもやもや病の患者さんで原始嗅神経動脈が前大脳動脈への側副血行路として機能していることが判明しました。長年、当科が実施している脳血行再建術（STA-MCAバイパス + EDMAPS術）ののち、この側副血行路が消失あるいは縮小することから、この手術が中大脳動脈のみならず、前大脳動脈領域にも十分な血流を供給していることが間接的に証明されました。
A Voyage to Depth of Neuroscience Vol. 55
One of our residents, Dr. Tetsuhiro Kamo published a paper entitled, Persistent Primitive Olfactory Artery as Novel Collateral Channel to the Anterior Cerebral Artery in Moyamoya Disease.
Kamo T, Uchino H, Saito H, Kashiwazaki D, Akioka N, Kuwayama N, Kuroda S.
J Stroke Cerebrovasc Dis. 2018 Nov 5. [Epub ahead of print]
Abstract
BACKGROUND:
There are a variety of collateral routes to compensate persistent cerebral ischemia in moyamoya disease. However, there is no report presenting the persistent primitive olfactory artery (POA) as a spontaneous collateral route to the anterior cerebral artery (ACA) in moyamoya disease.
METHODS:
We precisely examined cerebral angiography in 84 patients with moyamoya disease to identify the collateral channel through the persistent POA. Its anatomy was evaluated on pre- and postoperative angiography.
RESULTS:
Of 84 patients, four (4.8%) had spontaneous collateral channel through the persistent POA. All of these four hemispheres were categorized into Stage 5. In all four patients, the collateral blood flow arose from the ophthalmic artery and run to the persistent POA through the ethmoidal moyamoya. The persistent POA provided collateral blood flow from the ophthalmic artery to the ACA in all four patients. Superficial temporal artery to middle cerebral artery anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis was performed in three of four patients. After surgery, the collateral channel through the persistent POA completely disappeared or markedly regressed, suggesting a significant improvement of cerebral hemodynamics in the territory of not only the MCA but also the ACA.
CONCLUSION:
The persistent POA can potentially provide collateral blood flow to the ACA in about 5% of patients with moyamoya disease, and should be recognized as a novel collateral channel in moyamoya disease. The persistent POA may be useful to evaluate therapeutic effects of surgical revascularization on the ACA territory.
