An Indirect Revascularization Method in the Surgical Treatment of Moyamoya Disease:Various Kinds of Indirect Procedures and a Multiple Combined Indirect Procedure
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概要
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The indirect non-anastomotic bypass procedures for moyamoya disease are herein reviewed, and our multiple combined indirect procedure, i. e. a fronto-parieto-temporal combined indirect bypass proce-dure, is also introduced. Direct procedures such as superficial temporal artery-middle cerebral artery anastomosis are able to form collaterals with a high reliability, but these procedures are often difficult to technically perform in small children, and complications, when they occur, tend to be severe. In-direct procedures, such as encephalo-duro-arterio-synangiosis (EDAS), encephalo-myo-synangiosis (EMS), and encephalo-myo-arterio-synangiosis (EMAS) etc., are safe and easy and also successfully form collaterals especially in children with moyamoya disease. However, there are a few drawbacks with such procedures. They do not always form sufficient collaterals. The area where the original EDAS using the posterior branch of the superficial temporal artery can be done is also limited. Moreover, because the area covered by each single procedure is small, the collateral formation obtained by a single procedure is not always satisfactory. For these reasons we developed a fronto-temporo-parietal combined indirect bypass procedure for child patients in order to overcome these problems. This multiple combined indirect procedure can cover a wider area of the ischemic brain through the EMAS in the frontal and the EDAS and EMS in the temporo-parietal regions. It is also safe and easy to perform, and one or two of these three procedures form sufficient collaterals with a relatively high relia-bility. This technique is described and the results are presented.
- 社団法人 日本脳神経外科学会の論文
著者
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Inoue Tooru
Department Of Cerebrovascular Disease And Clinical Research Institute National Kyushu Medical Center
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Katsuta Toshiro
Department Of Neurosurgery Clinical Research Institute National Kyushu Medical Center Hospital
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Ikezaki Kiyonobu
Department Of Neurosurgery Graduate School Of Medical Sciences Kyushu University
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Natori Yoshihiro
Department Of Neurosurgery Aso Iizuka Hospital
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Matsushima Toshio
Department Of Neurosurgery Faculty Of Medicine Saga University
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Suzuki Satoshi
Department Of Advanced Cardiac Therapeutics Fukushima Medical University
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Fukui Masashi
Department Of Neurosurgery Faculty Of Medicine Kyushu University
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MATSUSHIMA Toshio
Department of Neurosurgery, Faculty of Medicine, Kyushu University
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IKEZAKI Kiyonobu
Department of Biochemistry, Oita Medical School
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IKEZAKI Kiyonobu
Department of Neurosurgery, Faculty of Medicine, Kyushu University
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KATSUTA Toshiro
Department of Neurosurgery and Clinical Research Institute, National Kyushu Medical Center
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