Neurological Surgery 脳神経外科50巻4号

2022年07月発行

特集 STA-MCAバイパス術—日本が世界に誇る技を学ぶ Ⅲ特殊なバイパス術

もやもや病に対するバイパス術Ⅱ：その特殊性，小児例に対する私の手術法

著者： 藤村幹¹ 伊東雅基¹

所属機関： ¹北海道大学大学院医学研究院脳神経外科学教室

ページ範囲：P.819 - P.825

Point
・もやもや病は東アジアに多い原因不明の頭蓋内動脈狭窄症で，小児ならびに若年成人の脳卒中の原因として重要である．
・虚血症状を呈するもやもや病に対しては脳血行再建術が推奨され，特に直接間接複合バイパス術が有効である．
・小児例ではバイパス術後急性期の脳循環が成人例と異なるため，小児例に特徴的な術後病態を勘案した周術期管理が重要である．

参考文献

1）Suzuki J, Takaku A：Cerebrovascular “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 20：288-299, 1969

2）冨永悌二，他：もやもや病（ウイリス動脈輪閉塞症）診断・治療ガイドライン（改訂版）．脳卒中の外 46：1-24, 2018

3）Fujimura M, et al；Research Committee on Moyamoya Disease（Spontaneous Occlusion of Circle of Willis）of the Ministry of Health, Labor Welfare, Japan；Guideline Committee 2021 of the Japan Stroke Society：2021 Japanese guidelines for the management of Moyamoya disease：guidelines from the Research Committee on Moyamoya Disease and Japan Stroke Society. Neurol Med Chir（Tokyo）62：165-170, 2022

4）Fujimura M, et al：Efficacy of superficial temporal artery-middle cerebral artery anastomosis with routine postoperative cerebral blood flow measurement during the acute stage in childhood moyamoya disease. Childs Nerv Syst 24：827-832, 2008

5）Rashad S, et al：Long-term follow-up of pediatric moyamoya disease treated by combined direct-indirect revascularization surgery：single institute experience with surgical and perioperative management. Neurosurg Rev 39：615-623, 2016

6）Fujimura M, Tominaga T：Lessons learned from moyamoya disease：outcome of direct/indirect revascularization surgery for 150 affected hemispheres. Neurol Med Chir（Tokyo）52：327-332, 2012

7）Fujimura M, Tominaga T：Current status of revascularization surgery for moyamoya disease：special consideration for its ‘internal carotid-external carotid（IC-EC）conversion' as the physiological reorganization system. Tohoku J Exp Med 236：45-53, 2015

8）Fujimura M, Tominaga T：Flow-augmentation bypass for Moyamoya disease. J Neurosurg Sci 65：277-286, 2021

9）Takagi Y, et al：Histological features of middle cerebral arteries from patients treated for Moyamoya disease. Neurol Med Chir（Tokyo）47：1-4, 2007

10）Fujimura M, et al：Cerebral ischemia owing to compression of the brain by swollen temporal muscle used for encephalo-myo-synangiosis in moyamoya disease. Neurosurg Rev 32：245-249, 2009

11）Fujimura M, et al：Incidence and risk factors for symptomatic cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with moyamoya disease. Surg Neurol 71：442-447, 2009

12）Fujimura M, et al：Efficacy of prophylactic blood pressure lowering according to a standardized postoperative management protocol to prevent symptomatic cerebral hyperperfusion after direct revascularization surgery for moyamoya disease. Cerebrovasc Dis 33：436-445, 2012

13）Fujimura M, et al：Minocycline prevents focal neurological deterioration due to cerebral hyperperfusion after extracranial-intracranial bypass for moyamoya disease. Neurosurgery 74：163-170, 2014

14）Hayashi, et al：Postoperative neurological deterioration in the pediatric moyamoya disease watershed shift and hyperperfusion. J Neurosurg Pediatr 6：73-81, 2010

I］iodoamphetamine single-photon emission computed tomography study. Acta Neurochir Suppl 132：57-61, 2021

I］iodoamphetamine single-photon emission computed tomography study. Cerebrovasc Dis, 2021［Epub ahead of print］doi：10.1159/000520801