もやもや病に対するRibbonen encephalo-duro-arterio-myo-synangiosis (Ribbon EDAMS) 施行例における術前・術後の脳循環動態の検討

Abstract

To evaluate the efficacy of Ribbon encephalo-duro-arterio-myo-synangiosis (EDAMS) for patients with childhood moyamoya disease, we analyzed pre- and postoperative cerebral hemodynamics at resting and at acetazolamide-challenging in the areas of the anterior cerebral arteries (ACAs) and the middle cerebral arteries (MCAs).We reviewed 10 children with moyamoya disease treated with Ribbon EDAMS. The value of cerebral perfusion (CP) was obtained by dividing the radioisotope uptake in each ROI by the mean uptake in the cerebellum measured using 99mTc-hexamethyl-propyleneamine oxime single-photon emission CT. The value of vasodilatory capacity (VDC) was defined as the change in CP of each ROI after acetazolamide-challenging.Pre-existing clinical symptoms disappeared after Ribbon EDAMS in 8 patients. The other 2 patients needed another supplementary reconstructive surgery to resolve the neurological problems. CP at resting in the areas of the MCAs (n=38) changed significantly from 0.98±0.18 to 1.04±0.16 (P<0.05). VDC in the areas of MCAs (n=26) also improved from -15±21% to +6±19% (P<0.01). Although the changes of CP at resting in the areas of the ACAs (n=32, from 0.93±0.19 to 0.96±0.11) were not significant, VDC in the areas of the ACAs (n=20) improved from -22±29% to +5±19% (P<0.01).We conclude Ribbon EDAMS is effective to improve hemodynamic compromise in both areas of the ACAs and the MCAs in patients with childhood moyamoya disease.