小児もやもや病におけるMultiple Burr-hole Operationの有用性について

Usefulness of Multiple Burr-hole Operation for Child Moyamoya Disease

I．はじめに

　もやもや病は脳血管撮影上の特徴として両側の内頸動脈末端部の狭窄または閉塞と大脳基底核部の異常血管網を示し，臨床的には繰り返す脳虚血発作と特に成人例においては出血を呈する疾患である^29）．また原因不明であり緩徐ではあるが進行性であることもよく知られている^13,21-23）．

　もやもや病に対して現在まで種々の治療法が開発されその有効性も証明されてきた．手術法としては，直接バイパス法と間接バイパス法があるが，これらはすべて全身麻酔を要するためしばしば周術期に合併症を起こすことも報告されている^4,27）．

Excellent results of multiple burr-hole operation (MBHO) for child moyamoya disease are reported inthis study. Three patients of moyamoya disease had MBHO. After MBHO, transient, ischemic attacks dis-appeared in a patient despite progressing stenosis of the major cerebral arteries, and remarkable neurolo-gical improvement was recognized in a patient who had encephaloduroarterlosynangiosis. Another patientslowly improved and became able to go to junior high school. N-isopropyl-p-[¹²³I]iodoamphetamine (IMP-SPECT) findings also improved in all patients. and There was no mortality or morbidity, and no new neurolo-gical deficits or bleedings developed during the follow up period, The authors recommend the MBHO asthe surgical treatment of choice for not only adult but also child moyamoyca disease because of its safetyand effectiveness, and also report the usefulness of MBHO for the patients who have already receivedother bypass operations.