2005 年 28 巻 1 号 p. 40-43
A 42-year-old Asian female with known moyamoya disease, clinically revealed as cerebral infarction and had been undergone bilateral EDAS (encephalo-duro-arterio-synangiosis) and single burr-hole operation in her right frontal region 12 years before, developed an acute subdural hematoma after head trauma in a traffic accident. Craniotomy preserving the site of EDAS was performed to remove hematoma. Transcranial anastomosis through a burr hole in her right frontal region for the purpose of neo-vascularization (burr-hole operation) was the main source of bleeding. Angiography performed postoperative day 11 showed that anastomoses of EDAS were preserved. Postoperative course was satisfactorily, she made full recovery and was discharged on postoperative day 22 in good condition as before the traffic accident. Only left side MMT (Manual Motor Testing) 4/5 weakness as before remained. This is the first report of acute subdural hematoma caused by the rupture of a transcranial anastomosis through a burr hole of burr-hole operation as well as the first report of good recovery in a patient with moyamoya disease underwent craniotomy for acute subdural hematoma. In this case, preserving the site of EDAS during the operation resulted in good outcome.
