カワシマ　アキツグ   Kawashima Akitsugu   川島　明次    所属   医学部 医学科（東京女子医科大学病院）    職種   准教授
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Successful superficial temporal artery-anterior cerebral artery direct bypass using a long graft for moyamoya disease: Technical note.
掲載誌名	正式名：Neurosurgery 略　 称：Neurosurgery ISSNコード：15244040/0148396X
巻・号・頁	67(ONS Suppl 1),pp.ons145-ons149
著者・共著者	KAWASHIMA Akitsugu†*, KAWAMATA Takakazu, YAMAGUCHI Kohji, HORI Tomokatsu, OKADA Yoshikazu
担当区分	筆頭著者,責任著者
発行年月	2010
概要	BACKGROUND: Although some patients with moyamoya disease need revascularization in the anterior cerebral artery (ACA) territory, there are few reports on direct bypass in the ACA territory because of the difficult surgical technique. OBJECTIVE: To report our technical strategy for superficial temporal artery (STA)-ACA bypass. METHODS: We performed simultaneous STA-ACA and STA-middle cerebral artery direct bypasses in 7 patients with moyamoya disease using the following strategies: creating 2 separate craniotomies for the 2 bypasses, dissecting a long STA graft and securing a recip- ient ACA around the bregma for the STA-ACA bypass, and using loose stitches at the anas- tomoses. One branch of the STA was dissected for a length of approximately 10 cm. The graft coursed on the brain surface under the bone bridge and was directly anastomosed to the cortical branch of the ACA. At the anastomoses, the stitches were widely spaced and loose to facilitate expansion of the orifice. RESULTS: This method prevented kinking of the graft. Postoperative angiograms revealed good patency of the STA-ACA bypass in all patients. After the bypasses, 5 patients no longer had transient ischemic attacks or stroke, 1 patient was almost completely free of transient ischemic attacks, and 1 patient had only residual contralateral symptoms. In all 7 patients, patency of the bypass was satisfactory during follow-up periods ranging from 9 to 23 months (mean 16.4 months). CONCLUSION: This method of STA-ACA bypass provides successful and reliable direct revascularization of the ACA territory in patients with moyamoya disease. Further investi- gation of the possible merit of this surgery in improving cognitive function is warranted.
DOI	10.1227/01.NEU.0000382975.86267.40