抄録
Surgical revascularization for such conditions as superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis and/or indirect synangiosis using STA, dura mater, temporal muscle and pericranium has been commonly recognized as standard treatment for patients with moyamoya disease. However, various postoperative complications have been reported. Of these complications, postoperative ischemic stroke influence prognosis. We retrospectively reviewed patients with ischemic complications after revascularization, and assessed the incidence and mechanism of this ischemic complication. For this study, postoperative ischemic complication was defined as a newly developed infarction within two weeks after surgery, which was confirmed by follow-up imaging studies.
This study included 84 hemispheres of 62 patients with moyamoya disease that underwent revascularization surgery between December 2006 and August 2011. Patients under four years of age were treated with indirect revascularization, from four to 39 of age with direct and indirect revascularization, and over 40 of age with direct revascularization.
Ischemic complications were found in five patients (7.2%) of six hemispheres (6.4%). All patients were male. The age at the time of surgery ranged from three to 44 (mean 19.3 years). These infarctions were located in the cerebral hemisphere ipsilateral to the site of surgery in five, and contralateral in one. All of them occurred within four days after surgery. Preoperative angiograms revealed disappearance of the anterior cerebral artery (ACA) and middle cerebral artery (MCA) and marked development collateral vessels from posterior cerebral artery (PCA) in all patients, and stenosis of PCA in two patients. Two patients were two-year-old infants, who made rapid progress just before indirect revascularization surgery.
In patients who exhibit dependence on PCA, careful postoperative management, such as control of blood pressure, is important to prevent these ischemic complications. It is also recommended that direct revascularization surgery be performed for any infants with rapid progression berore surgery.
