局所脳循環よりみた血行再建術に関する実験的研究

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The STA-MCA anastomosis or endarterectomy for cerebral infarction is performed widely as a treatment of cerebral infarction in various neurosurgical facilities. The effect of each method, however, has not yet been clarified up to the present. The authors measured the rCBF in dog's caudate neucleus, thalamus and midbrain, to estimate the effect of the revasculization of the middle cerebral artery (MCA). The rCBF in the caudate neucleus decreased gradually, after clipping of the MCA with a Scoville clip, for 6 hrs. On the other hand, no significant change was noted on the rCBF of the thalamus and the midbrain. In all cases, no brain swelling was observed through a window in the temporal bone which had been previously made. Immediately after releasing the occlusion of MCA, the rCBF in the thalamus and the midbrain increased rapidly, and then the flow decreased gradually. However, brain swelling was observed in 5 out of 8 dogs, and no significant change was noted on the rCBF in the caudate neucleus. Decrease of the rCBF after releasing of the occlusion may be considered to be brain swelling or edema under the condition of abnormal metabolism and/or vasoparalysis. Such a condition may occur by the clipping of the MCA and releasing the occlusion, effecting the circulation of the circle of Willis.<BR>This experimental study leads to the conclusion that the direct removal of the occlusion in a artery, such as endarterectomy, should be avoided because it will increase brain edema and make a decrease of rCBF in the thalamus and the midbrain.
The Japanese Society on Surgery for Cerebral Strokeの論文

局所脳循環よりみた血行再建術に関する実験的研究

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