浅側頭動脈・中大脳動脈皮質枝間吻合術により著効をみた一過性脳虚血発作の2症例

STA･MCA ANASTOMOSIS FOR THE TREATMENT OF TIA:A REPORT OF 2 CASES

I．はじめに

　脳神経外科領域における手術用顕微鏡の導入^12）と，その後のmicrovascuiar surgeryの発達^27）は，従来より，主として保存的療法にゆだねられていた頸部あるいは頭蓋内動脈の閉塞性疾患に対して，外科的治療の可能性をもたらした。すなわち，手術用顕微鏡下に直接血栓を除去したり^13,18,23），さらに近年にいたつては，頭蓋外動脈の血流を乏血脳へ供給しようとするextracranial-intrac—ranial bypass formation^{16,19,28,29）}が注目されるなど，閉塞性脳血管障害に対する治療への関心が高まつている。しかしながら，このbypass形成術も，ことに本邦では，いまだその歴史も浅く，またその適応もこれまでは，主に，固定した神経脱落症状を有する例が大多数をしめ，いわゆるTIA （Transient Ischemic Attack）を主症状とする閉塞性脳血管障害に対し，bypass形成術が行われることは比較的少ないと思われる。最近，われわれは，このTIAを主症状とする中大脳動脈閉塞症，および両側内頸動脈閉塞症の2症例に対し，浅側頭動脈・中大脳動脈皮質枝間吻合術（STA・MCA anastomosis）を行い，著明な臨床症状の改善をみたので，この2症例を提示し，若干の考察を加えて報告する。

STA･MCA anastomosis was performed in 2patients afflicted with recurrent transient ischemicattacks (TIAs) and both patients were liberatedfrom TIAs after the shunt operation.

Case 1. A 31-year-old man admitted to the hospi-tal complaining of the recurrent transient attacksof left-side hemiparesis (several times a day) overa period of two months. Results of physical andneurological examinations were within normallimits except hypertension. Right carotid angio-gram showed complete occlusion of the middlecerebral artery at M1 portion. The anastomosisbetween the right superficial temporal artery anda cortical branch of the middle cerebral artery wasperformed. The patient had no further attacksafter the STA･MCA anastomosis. Postoperativeangiogram showed a patent anastomosis with goodfilling of the middle cerebral artery through thenew shunt.

Case 2. A 53-year-old man was evaluated forrecurrent transient attacks of the left hemiparesiswith recovery. But, recently, he began to complainthe remaining weakness of left upper extremityfollowing attacks. About thirteen years previously,he had episodes of recurrent transient attacks. Pre-operative angiograms revealed complete occlusionof bilataral internal carotid arteries with collateralblood supply through the ophthalmic arteries andothers. Double anastomosis between the superficialtemporal artery and cortical branches of the middlecerebral artery was carried out. Postoperativeangiogram showed patent anastomosis and nofurther attacks had occurred after the shunt oper-ation.

Our recent experience of STA･MCA anastomosisto patient with TIAs was reported and its benefitwas discussed in this paper.