烟雾病
医学
血运重建
颞浅动脉
吻合
外科
搭桥手术
脑出血
缺血
大脑中动脉
动脉
心脏病学
蛛网膜下腔出血
心肌梗塞
作者
Kiyohiro Houkin,Hiroyasu Kamiyama,Hiroshi Abe,Akihiro Takahashi,Satoshi Kuroda
出处
期刊:Stroke
[Ovid Technologies (Wolters Kluwer)]
日期:1996-08-01
卷期号:27 (8): 1342-1346
被引量:201
标识
DOI:10.1161/01.str.27.8.1342
摘要
Background and Purpose It is well recognized that revascularization surgery using direct and/or indirect bypass provides effective surgical management for pediatric moyamoya disease. However, surgical treatment of the adult hemorrhagic type remains controversial. In this study, the effect of surgery for adult moyamoya disease was investigated. Methods We analyzed 35 patients with adult moyamoya disease (patient age, over 20 years), 24 patients with initial onset of intracerebral hemorrhage, and 11 patients with initial onset of cerebral ischemia who underwent both direct bypass surgery of the superficial temporal artery to the middle cerebral artery anastomosis and indirect revascularization of encephalo-duro-arterio-myo-synangiosis. Results Of 24 patients with hemorrhagic-type disease, 3 showed rebleeding; of 11 patients with the ischemic type, 2 showed intracerebral hemorrhage after surgery. Overall, 5 of 35 patients (14.3%) had hemorrhage after revascularization surgery (mean follow-up period, 6.4 years). Postoperative angiography revealed that direct anastomosis is effective whereas indirect revascularization is not always effective for adult moyamoya disease. Moyamoya vessels, which are supposed to be responsible for hemorrhage, decreased in 25% of patients. Conclusions Revascularization surgery cannot always prevent rebleeding. However, a decrease in moyamoya vessels was induced by surgery, which may reduce the risk of hemorrhage more effectively than conservative treatment. In cases of adult moyamoya disease, direct bypass is particularly important, since the indirect revascularization is not as useful in adult cases as in pediatric cases.
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