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Neurological Surgery No Shinkei Geka Volume 34, Issue 8 （August 2006）

Neurological Surgery 脳神経外科 34巻8号（2006年8月発行）

Japanese English

研究

もやもや病に対する血行再建術後急性期の臨床像と脳循環動態：脳灌流MRIを用いた検討 Diagnostic Value of Perfusion-weighted MRI for Evaluating Postoperative Alteration of Cerebral Hemodynamics Following STA-MCA Anastomosis in Patients with Moyamoya Disease 藤村幹 ¹ , 麦倉俊司 ² , 清水宏明 ³ , 冨永悌二 ¹ Miki FUJIMURA ¹ , Shunji MUGIKURA ² , Hiroaki SHIMIZU ³ , Teiji TOMINAGA ¹ ¹東北大学大学院医学研究科神経外科学分野 ²東北大学大学院医学研究科放射線診断科 ³広南病院脳神経外科 ¹Department of Neurosurgery,Tohoku University Graduate School of Medicine ²Department of Radiology,Tohoku University School of Medicine ³Department of Neurosurgery,Kohnan Hospital キーワード： moyamoya disease , superficial temporal artery-middle cerebral artery anastomosis , hyperperfusion , perfusion-weighted magnetic resonance imaging Keyword: moyamoya disease , superficial temporal artery-middle cerebral artery anastomosis , hyperperfusion , perfusion-weighted magnetic resonance imaging pp.801-809

発行日 2006年8月1日 Published Date 2006/8/1

DOI https://doi.org/10.11477/mf.1436100266

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Ⅰ．はじめに

　もやもや病は両側内頸動脈終末部，前および中大脳動脈近位部が進行性に狭窄・閉塞し，その付近に異常血管網の発達を認める原因不明の疾患である ¹³⁾．浅側頭動脈・中大脳動脈（STA-MCA）吻合術は本疾患による脳虚血を改善するための有効な治療法として広く用いられているが^4,11)，もやもや病に対するバイパス術後急性期の臨床症状や血行再建による急激な血流増加が脳循環代謝に与える影響についてはいまだ不明な点が多い．

　近年，非侵襲的な脳循環動態評価方法として脳灌流MRIが用いられるようになり，もやもや病においても術前の脳循環動態評価における有用性が報告されている^1,14)．しかしながら，もやもや病血行再建術後の脳循環動態評価におけるその有用性についての報告はごく限られている¹⁵⁾．特に術後急性期の脳灌流MRI所見についての報告は渉猟しえない．今回われわれは成人もやもや病手術例に対して脳灌流MRIと¹²³ I-IMP-SPECTを術後急性期に併用し，それらの所見の変化と臨床症状について検討したので報告する．

　Objective　Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). But little is known about the changes of CBF and its effect on neurological status during the acute stage after direct bypass for moyamoya disease.

　Methods and Results　Perfusion-weighted magnetic resonance imaging (PWI) by the SE-EPI method was performed 4 and 10 days after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis on 11 sides of 9 patients (male:female = 2:7,24-61 years old) with moyamoya disease. All patients underwent single-photon emission computed tomography (SPECT) 1 and 7 days after surgery. The time-to-peak (TTP) by PWI showed focal decrease at the site of the anastomosis 4 days after STA-MCA anastomosis compared to preoperative TTP,and was further decreased in larger territory 10 days after surgery in all patients. Postoperative cerebral blood volume (CBV) by PWI showed significant increase compared to preoperative CBV in four patients who suffered symptomatic cerebral hyperperfusion after surgery. Postoperative SPECT revealed apparent increase of CBF in all patients and the patency of the STA-MCA bypass was confirmed by MRA. All patients were discharged without neurological deterioration compared to preoperative neurological status,and none of them suffered ischemic attack after surgery.

　Conclusion　Postoperative decrease in TTP by PWI could be a sensitive parameter for the normalization of CBF after STA-MCA anastomosis in patients with moyamoya disease. Postoperative increase in CBV may suggest cerebral hyperperfusion and could be the optimal predictor for hyperperfusion syndrome after STA-MCA anastomosis in patients with moyamoya disease.