間接吻合術後症状の改善が得られず，直接吻合を加え軽快した成人モヤモヤ病の1例

Strategy for Vascular Reconstruction for Failed Indirect Anastomosis in Adult Moyamoya Disease—A Case Report

Ⅰ．はじめに

　小児モヤモヤ病に対する外科的治療は直接吻合術と間接吻合術に大別される．当院では，中大脳動脈領域の虚血に対してはsuperficial temporalartery-middle cerebral artery anastomosis（STA-MCA anast）with／without encephalo-myo-synangi-osis（EMS）^1,2）を施行してきた．

　今回，成人モヤモヤ病患者で，某大学附属病院でfronto-temporo-parietal combined indirect by-pass procedure^4）を受け，その後も一過性虚血発作を繰り返した症例に対する直接吻合術で工夫を要した症例を経験したので報告する．

There exist moyamoya disease patients who require vascular reconstruction for failed indirect anastomosis. In the present study, a 36-year-old female required ipsilateral direct anastomosis for failed right fronto-temporo-parietal combined indirect bypass procedure. One of the frontal branches of the right superficial temporal artery (STA) was left intact between the other frontal branch and a parietal branch of the right STA, both of which had been used in the indirect anastomosis. The intact STA was used for direct anastomosis, and craniotomy was performed between the two craniotomy sites of the first operation.