もやもや病に対する穿頭術を組み合わせた吻合術(<特集>もやもや病に対する外科治療)  [in Japanese] A Combined Bypass Surgery with Burr Holes for Moyamoya Disease(<Topics>Surgical Treatment for Moyamoya Disease)  [in Japanese]

The branches of external carotid artery were separately used to revascularize all areas supplied by ACA, MCA and PCA. The parietal branch of STA was usually used for an end to side anastomosis with a cortical branch of MCA. EDAS, using the proximal part of the frontal branch of STA, and EMS, using the inner layer of temporal muscle, were also performed in all pateints to stimulate spontaneous anastomosis. In addition, frontal burr holes were made to induce vascularization of the ACA areas from the distal part of frontal branch of ACA. If necessary, occipital burr holes in the area supplied by occipital artery was also added for the PCA territories. The first operation was performed on the dominant side, then a similar procedure was performed on the opposite side after an interval of at least 3 months. Postoperative clinical symptoms improved in most of the cases. The findings from MRI, MRA, angiography, and SPECT demonstrated an improvement of cerebral circulation through operative sites with disappearance of abnormal vessels. Rapid normalization of the EEG occurred within a year in more than half of the pateints. These results suggest that the placement of frontal and occipital burr holes, in addition to STA-MCA anastomosis, EDAS, and EMS, is effective in vascularizing the ischemic areas in patients with moyamoya disease.