STA-MCA吻合術の手術適応の検討:-体性誘発電位 (SEP) と術後機能予後 (ADL) の検討から-

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It is important to correctly predict prognostic physical function following to obstructive cerebrovascular dysfunctions including completed stroke. We have attempted to obtain reliable information as to the prognostic function from the investigation on the somatosensory evoked potential (SEP) recorded before and after the administrations of the solution of low molecular weight dextran (500ml/day) and urokinase (60,000 unit/day) for a period of 1 week to the patients of obstructive cerebral arterial dysfunction. The adaptability to the STA-MCA anastomosis of such patients was examined on the basis of the results thus obtained. The patient subjected to the study consisted of (1) 17 patients with middle cerebral arterial obstruction and (2) 5 patients with internal carotid arterial obstruction. The amplitude of the N2-N3 smaller than 3μV in predosing SEP was observed in 10 cases out of 17 for the patient group (1) and 3 out of 5 for the group (2), and that larger than 3μV was recorded from 7 patients out of 17 of the group (1) and 2 groups out of 5 of the group (2). Thirteen cases out of 17 in the group (1) and 4 cases out of 5 in the group (2) showed the change of EEG to slow wave pattern, and the ADL of these patients was assessed to be the degree of 2-3 (8 patients out of 17 in the group (1) and 2 patients out of 5 in the group (2) showed walking disability). After the drug administration, the increase in the amplitude of the N2-N3 to greater than 3μV, and the improvement of the EEG slow wave and of the ADL to the grade of 4 were observed in 10 cases out of 17 of the group (1) and 2 cases out of 5 of the group (2). Eight patients whose ages were younger than 60 years were selected from 13 improved cases and they were subjected to STA-MCA anastomosis. The back pressure during the surgery was 33±11 mmHg. The postsurgical improvement of the amplitude of the N2-N3 to greater than 5μV and good ADL were observed in 5 patients out of 8. In conclusion: 1) The increase in the amplitude of N2-N3 by the administration of a blood flow facilitating drug correlates with improvement of ADL, and it is useful for the prediction of prognostic function and may be serve as indicator for the adaptability to STA-MCA anastomosis of patients. 2) The amplitude of the N2-N3 recorded presurgically reflects the back pressure during the surgery.
The Japanese Society on Surgery for Cerebral Strokeの論文

STA-MCA吻合術の手術適応の検討:-体性誘発電位 (SEP) と術後機能予後 (ADL) の検討から-

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