もやもや病に対する間接的血管吻合術におけるfacts and myths-revisit-

抄録

I revisit items in an earlier paper of the same title, a review article that appeared in Nerv Syst Child (17: 219-229, 1992) with new conceptual understanding of the disease and its treatment. The items discussed are as follows. A. Is arachnoid incision needed in indirect anastomosis.? B. Does it take several months for an indirect anastomosis to have effects? C. Is surgery indicated for indirect anastomoses in the adult or the aged? D. Are indirect anastomoses less effective and trustworthy than direct operations? E. Does it matter little to discontinue the STA in the operation of moyamoya disease? F. Is surgery indicated for patients who just have occasional TIA attacks? G. Is surgery indicated for patients who just have headaches? H. Is surgery indicated for epileptic-type moyamoya patients? I. Is the operation not indicated for the seriously retarded? J. Are indirect anastomoses effective on the normal or infarcted brain? K. Under what circumstances is indirect anastomosis most effective? L. Should the operation be done bilaterally in one operation? M. Should an indirect operation be as extensive as possible?
The answers are as follows. A. No arachnoid incision is needed in indirect anastomosis. B. It takes only weeks for an indirect anastomosis to have effects. C. Indirect anastomoses are indicated for the adult and the aged. D. It has never been proved scientifically that indirect anastomoses are less effective and trustworthy than direct operations. E. Discontinuance of the STA should be avoided if possible during the operation of moyamoya disease. F. Surgery is indicated even for patients who just have occasional TIA attacks. G. Surgery is also indicated for patients who just have headaches. H. Surgery also is indicated for epileptic-type moyamoya patients. I. Surgery is also indicated for the seriously retarded. J. Indirect anastomoses are less effective on the infarcted brain and much less so on the normal brain. K. Indirect anastomosis is most effective on live, misery perfused or hemodynamically-stressed brain. L. If the operation is to be done in two stages, the patient should be cautiously followed because the unoperated side deteriorates very rapidly in some cases. M. There should be an optimal extensiveness of an indirect operation in each case.