出血発症もやもや病に対する直接血行再建術の効果および長期的予後について  [in Japanese] Direct Bypass of STA-MCA Anastonrosis Prevents Future Stroke in Patients with the Hemorrhagic Type of Moyamoya Disease  [in Japanese]

もやもや病は脳主幹動脈の閉塞性疾患であり,二次的に豊富な副血行路を認める原因不明の疾患である.小児を中心とする虚血発症のもやもや病に対する直接および間接血行再建術の有用性は一般に認められているが,成人発症例に多いとされる出血発作で発症したもやもや病は虚血症例よりも予後不良であり,これらに対する手術適応,手術手技についてはいまだ一定の見解が得られていない.今回われわれは出血発症したもやもや病に対して直接血行再建術(STA-MCA吻合術)を施行し,間接血行再建術(EDAS)施行例,保存的治療施行例と比較し,その長期予後を既報告以後に経験した症例とその後の経過についてさらに検討を加え,頭蓋内出血で発症したもやもや病の治療方針を示した.

The prevention of future stroke is an important issue in hemorrhagic type moyamoya disease. However, the surgical treatment of moyamoya disease in adult hemorrhagic type is still controversial. We undertook the present study to analyze the effect of direct surgery of STA-MCA anastomosis on the prevention of future stroke in patients with the hemorrhagic type of moyamoya disease. We analyzed 30 patients with adult moyamoya clisease whose mean age was 44 years old. The follow-up period was from 0.8 to 15.1 years after initial onset of intracerebral hemorrhage. Direct bypass surgery was performed on 10 patients and recurrence of hemorrhage was observed in 1 patient (10%) 9.3 years after first onset of hemorrhage. Indirect, Surgery was done on 6 patients, and 3 patients had future strokes (50%). Of the remaining 14 patients treated conservatively, stroke recurred in 8 patients (57%) during follow-up (average 2.71 years). The rate of future strokes and stroke-free time in the patients treated with direct bypass surgery was significantly lower (P< 0.05) than that of patients managed conservatively or with indirect bypass surgery. In conclusion, in case of adult hemorrhagic type of moyamoya disease, direct, bypass of STA-MCA anastomosis effectively prevents rebleeding and ischemic events.