もやもや病の直接吻合術におけるより確実な方法

Strategy for Direct Anastomosis in Moyamoya Disease

　Ⅰ．はじめに

もやもや病は両側内頸動脈先端部を中心に緩徐な閉塞が起こり，その代償としてそれらの末梢への側副路が発達してくる．

　もやもや病の虚血に対しては間接吻合術，直接吻合術あるいは両者を組み合わせた方法が適用される．

　今回，中大脳動脈領域の虚血に対して施行される直接吻合術である浅側頭動脈（STA）‐中大脳動脈（MCA）吻合術1)の際の手技上の工夫につき筆者の経験をもとに，より確実な吻合の工夫を述べる．

　Direct and/or indirect revascularization is usually performed in the surgical management of moyamoya disease.

　The surgical technique for direct anastomosis is thought to be difficult in some patients with moyamoya disease. In the present report,a more reliable technique for direct anastomosis is reported and clemon strated.

　Strategy for hemostatic procedure on the dura mater,preservation of fine branches originating from a recipient artery,opening of the recipient artery,and the technique for an anastomosis between a superficial temporal artery and a branch of the middle cerebral artery are discussed.