もやもや病に対するMultiple Burr-hole Operationの有用性と問題点について(<特集>もやもや病に対する外科治療)  [in Japanese] Usefulness and Problem of Multiple Burr-hole Operation for Moyamoya Disease(<Topics>Surgical Treatment for Moyamoya Disease)  [in Japanese]

We report excellent results for 20 patients who underwent multiple burr-hole operations for moyamoya disease. Beginning at a year postsurgery, angiograms disclosed rich neovascularization at 86 of 95 burr-holes, first from the middle meningeal artery, then from the superficial temporal artery. Neovascularization did not occur at 9 burr holes at which there were subdural effusion, local cerebral atrophy, and rich collaterals. Transient ischemic attacks disappeared in 8 patients and remarkably decreased in 1 patient. Preoperative symptoms improved in 5 of the patients who presented with cerebral infarction, in 3 patients with intracerebral hemorrhage, and in 3 patients with intraventricular hemorrhage. In 4 of 9 patients in whom moyamoya disease progressed angiographically, the symptom recurred but finally improved after addition of the burr-holes. Another 5 patients presented no new symptoms. In a patient with intracerebral hemorrhage, a small rebleeding occurred with no symptom. A high rate (10%) of chronic subdural hematoma occurred postoperatively. We strongly recommend the multiple burr-hole operation as the surgical treatment of choice for moyamoya disease because of its safety and effectiveness.