モヤモヤ病4例に対する手術効果の検討
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Last seven years we operated on four cases of moyamoya disease, one of which was the ischemic type and three the hemorrhagic ones.<br[I] Left STA-MCA anastomosis and encephalomyosynangiosis were performed on a three year-old girl with six times of TIA (case 1). This case developed total aphasia postoperatively. The postoperative CT scan showed bilateral cortical infarctions and left thin subdural fluid collection. Afterthere this case has been aphasic for two years. We thought that low PaCO<SUB>2</SUB> (below 35mmHg) induced by the hyperventilation and the operative sacrifice of the middle meningeal artery were main causes of these cortical infarctions and aphasia. [II] Total removal of intracerebral hematomas were performed in three cases of adults (case 2, 3 and 4). All intracerebral hematomas were on the left side of the hemisphere. Ventricular ruptures were present in case 2 and 3. The postoperative conscious level was III-1 in case 2 and 4, and II-2 in case 3. Postoperative CT scan showed low density areas located in the subcortical areas but sparing the basal ganglia in case 2 and 3, while the low density area located within the basal ganglia in case 4. The follow-up period was 2Y3M in case 2, 2Y6M in case 3 and 6M in case 4. The outcome was Grade I in case 2 and 3, and Grade III in case 4. We thought that difference of ADL between case 2, 3 and 4 chiefly depended on the location of the intracerebral hematoma. In conclusion<BR>In case of the operation for the moyamoya disease, (1) the hypocapnea should not be induced and the transdural anastomosis should not be sacrificed, particularly in the ischemic type, and (2) the early removal of intracerebral hematoma should be done whenever the patient's consciousness deteriorates progressively.<BR>* A. D. L.: classified by Kanaya et al.
- The Japanese Society on Surgery for Cerebral Strokeの論文
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