ASAI Junichiro Faculty of Medicine, Showa University, Lecturer, 医学部, 講師 (10151010)
SUZUKI Ryuta Faculty of Medicine, Showa University, Associate Professor, 医学部, 助教授 (10119216)
|Budget Amount *help
¥2,300,000 (Direct Cost : ¥2,300,000)
Fiscal Year 1997 : ¥900,000 (Direct Cost : ¥900,000)
Fiscal Year 1996 : ¥1,400,000 (Direct Cost : ¥1,400,000)
We developed a new indirect anastomosis, reversed durapexia (RDP), for surgical treatment of cerebral ischemia. The technique is simple and minimally invasive, and it allows significant anastomotic vessels to grow in the brain.
The technique involves reversing a strip of dura mater including a meningeal artery. We have performed this procedure in 16 patients, 8 patients with moyamoya disease and 8 patient with athelosclerotic cerebral ischemia. Based on the analysis of clinical cases, we proposed a criteria for the operation. Post-operatively, patient showed good neovascularity and improvement of clinical symptoms and cerebral blood flow.
In order to improve this RDP to ideal procedure, we performed experiments using ischemic rats with middle cerebral artery occlusion. The distribution and time course of growth factors in ischemic brain were observed. Growth factors, VEGF, bFGF, TGF_<beta> were recognized at marginal portion of infarcted area. These factors were seen from 3H to 1M and VEGF was remarkably seen 1W after the surgery.
Simultaneously, we stained microvessels with Factor 8 and CD31 and observeed the changes of number of microvessels in the ischemic lesions. We could recognize the increase of the number at the surounding part of the ischemic lesion. However, the increase was not remarkable and mainly seen in basal ganglia one week after the surgery.
To see neovascularity, we exposed dura mater and made incisions in the teritory of the occluded middle cerebral artery. Three weeks later, increase of the number of vessels was recognized under the brain surface. According to our data, growth factors appeared at the marginal portion of the infarcted area might induce neovessels from incised dura.
We reported these results at the several international and domestic scientific meetings.