痴呆症状の改善に有用であった浅側頭動脈・中大脳動脈吻合術の経験

Anastomosis of the Superficial Temporal Artery to the Middle Cerebral Artery for Occlusive Disease of the Bilateral Internal Carotid Arteries with Dementia

I．はじめに

　平均寿命が非常に伸びてくるにつれて，老年期における痴呆患者は増加し，近年，社会問題となっている．老年期で痴呆症状を呈する疾患は多いが，その双璧は脳血管性痴呆と老年痴呆（Alzheimer病を含む）である．両疾患の罹患頻度に関しては，欧米では，1対5-10ぐらいの比率で老年痴呆が多く，本邦では，1対3-5ぐらいの割り合いで脳血管性痴呆が多いと報告されている^6）．われわれは最近，突発性症状で発症し，その後次第に知能障害を呈した両側内頸動脈閉塞症の2症例に浅側頭動脈・中大脳動脈吻合術（以下STA-MCA bypass）を行い，著明な臨床症状および高次脳機能の改善を認めたので，症例を呈示するとともに，血管性痴呆の診断やその手術適応について若干の文献的考察を加え報告する．

Two cases are reported of occlusive disease of the bi-lateral internal carotid arteries with dementia in which the anastomosis of the superficial temporal artery to the middle cerebral artery (STA-MCA bypass) resulted in marked improvement in clinical aspects. One patient was a 29-year-old male who complained of transient weakness of the extremities and memory impairment.

Computerized tomography (CT) scans showed mul-tiple small infarctions, while cerebral angiography de-monstrated findings of Moya-like disease.

The cognitive function tests were subnormal and the study of cerebral blood flow (CBF study) showed dif-fuse low flow in both hemispheres. Based on his clinic-al symptoms and CBF study, the STA-MCA bypass was performed on both sides in two stages without complications.