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深淵なるニューロサイエンスへの旅 Vol. 77

当科の山本修輔先生のもやもや病に関する論文が「Journal of Stroke and Cerebrovascular Diseases」誌に掲載されました。本疾患では、もやもや血管は脳血流量が不足している脳にとっては重要な側副血行路ではありますが、もやもや血管に過大な血流負荷がかかると出血性脳卒中を引き起こしてしまいます。近年の研究によって、もやもや血管は線条体チャンネル、視床チャンネル、脈絡叢チャンネルに分類すると、病態を理解するのに有用であることが判明しています。今回、われわれは、長年われわれが実施しているSTA-MCA吻合術+EDMAPSがこれらのチャンネルにどのような効果を及ぼしているのかを検討しました。その結果、本術式は全てのチャンネルのもやもや血管を著しく消退させていることが判明しました。この結果はSTA-MCA吻合術+EDMAPS術後の長期予後がきわめて良好であるとの先年のわれわれの報告ともよく一致した結果です。

A Voyage to Depth of Neuroscience Vol. 77

Yamamoto S, Kashiwazaki D, Uchino H, Saito H, Hori E, Akioka N,
Kuwayama N, Kuroda S

Ameliorative Effects of Combined Revascularization Surgery on
Abnormal Collateral Channels in Moyamoya Disease

J Stroke Cerebrovasc Dis 2021 Jan 27 [epub ahead of print]

Abstract

Object: Abnormal collateral channels, so-called moyamoya vessels, play a critical role to compensate cerebral ischemia, but carry the risk for hemorrhagic stroke in moyamoya disease (MMD). The present study was aimed to clarify if superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and encephalo-myo-duro-arterio-pericranial synangiosis (EDMAPS) can efficiently regress the abnormal collateral channels in MMD patients.

Methods: This study included 92 hemispheres of 61 MMD patients who underwent STA-MCA anastomosis combined with EDMAPS between 2013 and 2019. There were 17 children and 44 adults. We retrospectively analyzed the findings on cerebral angiography before and 3 to 6 months after surgery, including Suzuki’s angiographical stage, the development of surgical collaterals, and the extent of abnormal collateral channels such as lenticulostriate, thalamic, and choroidal channels.

Results: Following surgery, no pediatric and adult patients experienced any stroke during follow-up periods (40.2±25.5 and 54.9±19.7 months, respectively). Suzuki’s stage significantly advanced in both adult and pediatric patients after surgery (P=0.042 and P<0.001). In adult patients, all of the lenticulostriate, thalamic, and choroidal channels significantly regressed after surgery (P<0.001, P=0.012, and P=0.004, respectively). In pediatric patients, however, lenticulostriate and choroidal channels significantly regressed (P=0.005 and P=0.034, respectively). Correlation analysis revealed that the development of surgical collaterals determined the postoperative regression of choroidal channels (P<0.001).

Conclusion: STA-MCA anastomosis and EDMAPS may be one of the most effective procedures to widely provide surgical collaterals to the operated hemispheres and prevent not only ischemic but also hemorrhagic stroke by regressing the hemorrhage-prone abnormal collateral channels in MMD.

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