"もやもや"病における成人例の検討

STUDY ON ADULT CASES WITH MOYAMOYA DISEASE

　抄録　"もやもや"病成人例51症例について，その臨床像，神経放射線学的特徴，外科治療を検討した。うち13例に，15歳以下の小児期に脳虚血発作の既往を認め，これをjuvenile onset，他をadult onsetとして分類した。juvenile onsetの症例では，小児"もやもや"病に似て，皮質動脈に閉塞性病変が進展していることが多く，STA-MCA double anastomosesにEMSを加えて行ない，なるべく広範囲にわたって頭蓋内を外頸動脈から灌流する事が重要であると考えられた。一方，adult onsetの症例では皮質動脈にまで閉塞性病変の及んでいる事が比較的少なく，leptomeningeal anastomosisが発達するという，通常の内頸動脈閉塞症や中大脳動脈閉塞症と類似した病態を示し，STA-MCA anastomosisのよい適応と考えられた。

Fifty-one adult patients with moyamoya disease were studied. Among these, thirteen cases, which had the history of cerebral ischemic attack during childhood, are classified as the cases of juvenile onset. The other thirty-eight cases were classified as those of adult onset. In most of the cases of juvenile onset, occlusive lesions also affected cor-tical arteries. For these cases, it is important to perform STA-MCA double anstomoses and ence-phalo-myo-synangiosis. Those of adult onset re-sembled the pathophysiology of internal carotid artery occlusion, or that of middle cerebral artery occlusion, since few cortical artery occlusion was noted, and leptomeningeal anastomosis was well developed. STA-MCA anastomosis was considered to be the treatment of choice in those of adult onset.