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Brain and Nerve No to Shinkei Volume 42, Issue 2 （February 1990）

Brain and Nerve 脳と神経 42巻2号（1990年2月発行）

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上頸神経節の脳循環代謝に及ぼす影響—モヤモヤ病の上頸神経節切除術からの検討 INFLUENCE OF SUPERIOR CERVICAL GANGLION ON CEREBRAL HEMODYNAMICS : MEASUREMENTS OF CEREBRAL BLOOD FLOW AND METABOLISM DURING SUPERIOR CERVICAL GANGIONECTOMY IN PATIENTS WITH MOYAMOYA DISEASE 佐藤博雄 ¹ , 小川彰 ¹ , 高橋明 ² , 藤原悟 ³ , 桜井芳明 ¹ , 嘉山孝正 ¹ , 吉本高志 ² H. Sato ¹ , A. Ogawa ¹ , A. Takahashi ² , S. Fujiwara ³ , Y. Sakurai ¹ , T. Kayama ¹ , T. Yoshimoto ² ¹国立仙台病院脳卒中センター脳神経外科 ²東北大学脳研脳神経外科 ³広南病院脳神経外科 ¹Stroke Center, Sendai National Hospital, Division of Neurosurgery ²Institute of Brain Diseases, Tohoku Uuiversity School of Medicine ³Division of Neurosurgery, Konan Hospital キーワード： Moyamoya disease , Ganglionectomy , cortical blood flow , cerebral metabolism , intraoperative monitoring Keyword: Moyamoya disease , Ganglionectomy , cortical blood flow , cerebral metabolism , intraoperative monitoring pp.203-208

発行日 1990年2月1日 Published Date 1990/2/1

DOI https://doi.org/10.11477/mf.1406900024

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Abstract 文献概要
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　最近我々はMoyamoya病に対しEDASと同時に上頸神経節切除術（SCG）を行っている。本報では同症例の術中脳循環代謝測定からSCGの脳循環代謝に及ぼす効果について検討した。対象，方法：12例のMoyamoya病の15側に手術が行なわれ，年齢は小児例9例，成人例3例，発症様式は虚血が7例，出血が4例，けいれんが1例であった。EDASを行なうための開頭から脳表にLaser Doppler組織血流計および組織酸素分圧電極，組織炭酸ガス分圧電極を，頸動脈には電磁流量計を設置し，SCG前後の各パラメーターの連続的変化を測定記録した。同時に股動脈より体血圧を測定した。結果：上頸神経節の切断に伴い，血圧は一過性に降下するがその後徐々に回復し，15分で切除前値よりやや高値となった。脳循環血流量および頸動脈血流量はSCG直後はほとんど変化しなかったが，30分後には切除前値に比し前者は平均18.8％，後者は平均13％の増加を示し，前者は1％以下の危険率で有意の差があった。これに伴い脳表酸素分圧の増加は認められたが，炭酸ガス分圧はほとんど変化しなかった。結語：上頸神経節切除術はMoyamoya病において術後早期より有意な脳血流の増加を得ることができる手術と考えられた。

The effect of superior cervical ganglionectomy (SCG) on cerebral blood flow and metabolism was investigated in moyamoya disease.

Measurement of cerebral blood flow and meta-bolism was performed in 12 cases (15 operations) of moyamoya disease during SCG. Mean age was65. 2 years (from 3 to 38). 4 were male and eight were female. Ischemic cases were 8 and hemorr-hagic cases were 4.

At encephalo-duro-anterio-synangiosis, a Lazer Doppler flow meter and probes for measuring cor-tical tissue oxygen and carbon dioxide were set ut to allow measuremenst from identical sites on the surface of the brain over the cortex. More-over, an electromagnetic flow meter was placed on the common carotid artery. And the mean arterial blood pressure was also measured from femoral artery. After the electrode had been stabilized, continuous recordings were made of cerebral blood flow and metabolism during SCG.

The mean arterial blood pressure fell slightlypost operatively, but the changes in blood pressure were considered not to be significant enough to affect blood flow. Cortical CBF did not change immediately after SCG. However it increased gra-dually to 118. 8% of preoperation level 30 minutes later respectively, and the difference was observed significant. The carotid blood flow and the tissue oxygen developed a tendency to increase after 30 minutes, but the tissue carbon dioxide did not changed.

The present study indicates that superior cer-vical ganglionectomy is the useful procedure to increase in cerebral blood flow immediately after the operation on patients with moyamoya disease.