北海道大学、富山大学で一緒に働くことができた齋藤久泰先生の論文が欧州脳神経外科学会の機関誌「Acta Neurochir (Wien)」誌に掲載されました。今回は、初発時から後大脳動脈に狭窄病変を有するために側頭葉〜後頭葉に高度の脳虚血を有する、もやもや病に特異的な神経症候、脳梗塞の局在、そして、内頚動脈＋後大脳動脈領域全てをカバーする一期的脳血行再建術の治療成績について報告させていただきました。こういった症例の頻度はそれほど高くないものの、通常の脳血行再建術を実施してしまうと思わぬ合併症をきたすリスクが高いため注意が必要です。
A Voyage to Depth of Neuroscience Vol. 74
Dr. Hisayasu Saito, one of our staffs, has published specific clinical features and one-stage revascularization surgery for moyamoya disease with severe cerebral ischemia in the territory of posterior cerebral artery.
Saito H, Kashiwazaki D, Uchino H, Yamamoto S, Houkin K, Kuroda S.
Specific clinical features and one-stage revascularization surgery for moyamoya disease with severe cerebral ischemia in the territory of posterior cerebral artery.
Acta Neurochir (Wien). 2020 Sep 14. doi: 10.1007/s00701-020-04580-7. Online ahead of print. PMID: 32929541
Background: There are no reports describing the surgical procedure for moyamoya disease (MMD) patients with severe cerebral ischemia in the territory of the posterior cerebral artery (PCA) at initial presentation. In this study, therefore, we describe their clinical and radiological features and clinical results of one-stage revascularization surgery for both anterior and posterior circulation.
Methods: This study included 6 MMD patients who had severe cerebral ischemia in the PCA territory and underwent one-stage revascularization surgery for both anterior and posterior circulation. Of these, one patient underwent it on both sides. Their clinical and radiological data were precisely analyzed. Compared with usual procedure, craniotomy was extended towards the temporo-parietal area more widely. The parietal branch of superficial temporal artery (STA) was anastomosed to the angular or posterior temporal artery, while the frontal branch was anastomosed to the frontal branch of MCA. Ultimate indirect bypass was added. Their clinical and radiological outcomes were evaluated.
Results: Their neurological symptoms included visual and speech disturbance as well as numbness of the extremities. Cerebral infarct was distributed in the posterior temporal, parietal, and/or occipital lobe. Cerebral hemodynamics and metabolism were also impaired in the same regions. These findings were completely different from those in MMD patients without PCA lesion. Postoperative course was uneventful, and none of them recurred stroke during a mean follow-up period of 10.5 years. Surgical collaterals widely provided blood flow to the entire hemispheres, including the occipital lobe. Cerebral hemodynamics and metabolism markedly improved after surgery.
Conclusion: One-stage revascularization surgery for both anterior and posterior circulation is feasible and effective to prevent future stroke in MMD patients with severe cerebral ischemia in the PCA territory at initial presentation.