後頭動脈-後下小脳動脈吻合術の臨床的検討

概要

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Recently, occipital (OA)-posterior inferior cerebellar artery (PICA) anastomoses have been performed for some cases with infratentorial ischemic disorder. Until now, it is not yet enough to analyse whether the OA-PICA bypass is beneficial or not for ischemic disorders of vertebro-basilar (VA-BA) territories. In this paper, the authors discussed some problems about the indication and the limitation of reconstructive surgery extracted from clinical courses, neuroradiological findings, and follow-up studies of 2 operated cases and 3 conservatively treated cases with survival. In all of 3 survived cases of VA-BA occlusion, treated conservatively, Locked-in-like syndromes with alertness and tetraplegia were observed. Neuroradiologically, focal pontine infarctions were detected by CT scans but uni or bilateral patent VAs and PICAs were revealed in serial vertebral angiograms. From these findings, it is considered that the circulations in small perforating branches of BAs were disturbed. On the other hand, 2 operated cases, which had one-sided VA occlusion with stenosis of the other, showed not enough blood flow to VA-BA territories via OA-PICA anastomoses in postoperative angiograms. From these results mentioned above, it is suggested that the OA-PICA anastomosis would be enough to preserve the life but not complete functions of brain stems and that another methods of bypass operation with high perfusion pressure should be developed.