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Touho Neurosurgery Clinic
Address:2-2-17, MIDORIGAOKA, IKEDA, OSAKA, JAPAN 563-0026 |
Surgical technique on moyamoya disease
Hajime Touho, M.D.
Department of Neurosurgery
Touho Neurosurgical Clinic
Moyamoya disease is a slowly progressive cerebrovascular disease. Steno-occlusion gradually develops at the terminal portion of the internal carotid artery bilaterally. Ischemic symptoms include hemiparesis, monoparesis, paraparesis, urinary incontinence, visual disturbance, motor aphasia and so on. Headache, convulsion, or intracranial hemorrhage may occurs. Surdical treatment of moyamoya disease includes direct and/or indirect anastomosis. The former includes superficial temporal artery-middle cerebral artery(STA-MCA) anastomosis and the latter includes encephalo-duro-arterio-synangiosis, encephalo-myo-synangiosis, encephalo-galeo-synangiosis, omental transplantation, gracilis muscle transplantation, and so on. Direct with/without indirect anastomosis is usually performed in the territory of the MCA.
I have treated 852 cases/24 years with moyamoya disease , surgically. In the last nine years, 352 cases/214 patients have been treated. The latter group includes 65 male and 149 female. 139 patients were under sixteen years in age and 75 patients were over 17 years in age. Direct with/without indirect anastomosis was performed on 204 cases and indirect anastomosis was on 148 cases.
In the present study, various technique on the surgical treatment of moyamoya disease is reported.
Troublesome and time-consuming problems may occur during operation with direct anastomisis. They are as follows;
1)Diameter of a branch of the MCA(recipient artery) may be less than 0.3 mm. Four out of the 852 cases had the diameter of 0.2 mm.
2)Pulsation of the brain sometimes lets the procedure become difficult.
3)The wall of a branch of the MCA is sometimes thin and translucent.
4)Fine branches are originated from a branch of the MCA(recipient) and obtaining a sufficient width for direct anastomosis is thought to be difficult without sacrifice of the fine branch(es).
5)STA may be stenosed or occluded by a temporary clip aplied to the STA, especcilay in adult cases and by heat damage with electrocoagulation.
Various technique to overcome these problems will be presented in the present report.
?Omental transplantation is one of indirect anastomosis but it is a time-consuming procedure. Anastomosis between superficial temporal vein/occipital vein and gastroepiploic vein(GEV) may be mechanically occluded during closure of the skin. Anastomosis between GEV and a cortical vein will be shown in the present report.
International Conference on Cerebrovascular Surgery
Nov 11, 2009
lecture in Evening seminar
Nagoya, Japan
revision of the above statistics on Nov 25, 2009
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stastatics
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1)I've performed five hundred cases by Feb,2000,
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? and 340? cases with ischemic type between March,2000 and Feb, 2009.
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2)The latter period included 340 cases in 206 patients with ischemic symptoms.
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3)those patients included 140(68.0%) females and 66(32.0%) males.
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4)under 16 years old in age, 86(63.7%) were females and 49(36.3%) were males.
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5)over 16 years old in age, 54(76.1%) were females and 17(23.9%) were males.
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6)there were 71 patients(34.5%) and 135 patients(65.5%).
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7)direct anastomosis was performed in 196 cases(57.6%) and indirect anastomosis in 144 cases(42.4%).
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8)cerebral infarction occured in 7 cases(2.06%) out
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of 340 cases.
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9)cerebral infarction occured in 4 cases(4.21%) out of 95 cases in patients of which age was over 16 years old, it occured in 3 cases(1.22%) out of 245 cases in patients of which age was under 16 years old.
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10) intraoperative acute brain swelling occured in 3 cases(0.88%) out of 340 cases.
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11)postperative brain edema occured in 1 case(0.29%)
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out of 340cases.
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12)hemorrhagic infarction occured in 1 case(0.29%) out of 340 cases.
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13)postoperative convulsion occured in 3 cases
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(0.88%) out of 340 cases.
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14)periopoerative infection occured in 2 cases
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(0.59%) out of 340 cases.
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15)about 80% of the pateints having operation showed disappearance of TIAs by three months.
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16)82/245 of which age was under 16 years old had 2 times operation
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17)51/95 of which age was over 16 years old had single operation.
- In near future
- I will revised and add new informations.