もやもや病に対するencephalo-galeo-synangiosisの効果

抄録

We studied the angiographical effect of the encephalo-galeo-synangiosis (EGS) for moyamoya disease in each EGS of multiple EGSs method and selective EGS method, including combined methods such as the superficial temporal-middle cerebral artery anastomosis (STA-MCA) and encephalo-myo-synangiosis (EMS) with frontal (F-) and/or occipital (O-) EGS, EMS+EGS method and single F-EGS method. Furthermore, we compared postoperative filling area of the cerebral hemisphere via external carotid arteries after surgery between multiple EGSs method and selective EGS method except for single F-EGS method.
Revascularization rate of each EGS-the percentage of EGS sites developed that collaterals-was 60% (46/77 sites) in multiple EGSs method and 71% (52/73 sites) in selective EGS method, including 70% (37/53 sites) in F-EGS and 75% (15/20 sites) in O-EGS. There was no definite difference of revascularization rate between patients 15 years old or younger (younger group) and patients 16 years old or older (older group) in both multiple EGSs and selective EGS methods.
In multiple EGSs method, the filling area of the cerebral hemisphere was more than two-thirds of the hemisphere in 39% of 18 hemispheres operated, one-third to two-thirds in 22% and less than one-third in 39%. On the other hand, the filling area of the hemisphere after combined method and EMS+EGS method was more than two-thirds in 61% of 51 hemispheres, one-third to two-thirds in 35% and less than one-third in 4%. F- and O-EGS developed collaterals in the area of the anterior cerebral and posterior cerebral arteries, respectively. There was no difference of good filling rate of hemispheres between younger and older groups in both multiple EGSs and selective EGS methods. EGS can be done in any sites of the brain, and important factors to increase revascularization rate seem to be certain detection of areas with low cerebral blood flow without infarction, wider attachment of the galea to the brain, and preservation of the scalp and meningeal arteries that can be feeding arteries of EGS. Postoperative filling area of the cerebral hemisphere in the lateral view via external carotid arteries was wider in combined and EMS+EGS methods than in multiple EGSs method. The combined method including STA-MCA, EMS, F-EGS and/or 0-EGS seemed to be satisfactory to develop sufficient collateral formation of the cerebral hemisphere via the external carotid arteries without causing scalp complications.