모야모야질환을 동반한 산모 9예의 임상적 고찰
Clinical review of 9 cases of pregnant women with Moyamoya disease
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모야모야질환으로 진단받은 산모들의 임상적 특징 및 치료 경과를 분석하여 임신과 출산의 치료방침을 확립하고자 한다. 본원에서 모야모야질환으로 진단받고 분만한 환자는 총 9예였다. 분만 전 진단받은 4예와 분만 후 진단받은 2예에서 제왕절개술로 분만하였고, 1예에서만 전신마취를 하였고 5예에서는 경막외 마취 또는 척수 및 경막외 마취를 하였다. 임신 중 진단받은 1예는 경막외 마취로 질식 분만하였고, 분만 후 진단받은 또 다른 2예는 질식 분만하였다. 3예 (33.3%)에서 임신 중 두개내 출혈, 중증 자간전증과 뇌졸중과 같은 합병증이 발생하였다. 5예는 만삭 분만하였고 4예는 조산하였으며 출생 후 신생아의 합병증은 없었다. 모야모야질환을 진단받은 산모의 분만에서 혈압의 유지가 중요한 요소로 척수 마취 또는 경막외 마취를 고려하는 것이 합병증을 줄이는 방법이 될 것이다. 더불어 산전 및 산후에도 기저질환에 대한 꾸준한 관리가 필수적이다.
Abstract
To describe the clinical manifestations and to establish the management of pregnancy and delivery in pregnant patients with Moyamoya disease. We identified nine women with Moyamoya disease. Six of these patients underwent cesarean section. General anesthesia was administered to only one patient, while epidural or combined spinal-epidural anesthesia was used for the others. The patient diagnosed during pregnancy was epidural anesthesia used for vaginal delivery and two patients diagnosed during post-delivery were delivered vaginally without anesthesia. Three patients showed pregnancy-related complications: intracranial hemorrhage, severe pre-eclampsia, and stroke. Five patients had term delivery, and four had pre-term delivery. The babies were healthy and had no complications. As blood pressure control is the most important factor for the pregnant women with Moyamoya disease, we recommend a spinal or epidural anesthesia in order to reduce the potential complications. Management of the patient’s underlying disease is also crucial.
참고문헌 (19)
- Fukui M, "Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis ("Moyamoya" disease). Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan", Clin Neurol Neurosurg, 99(2), pp.S238~S240 (1997)
- Mehrkens JH, "Management of haemorrhagic type Moyamoya disease with intraventricular haemorrhage during pregnancy", Acta Neurochir (Wien), 148, pp.685~689 (2006)
- Kim TS, "Moyamoya disease with repeated intracranial haemorrhage in two consecutive pregnancies", J Clin Neurosci, 11, pp.525~527 (2004)
- Suzuki I, "Cerebrovascular "Moyamoya" disease. Disease showing abnormal net-like vessels in base of brain", Arch Neurol, 20, pp.288~299 (1969)
- Wakai K, "Epidemiological features of Moyamoya disease in Japan: findings from a nationwide survey", Clin Neurol Neurosurg, 99(2), pp.S1~S5 (1997)
- Kuriyama S, "Prevalence and clinicoepidemiological features of Moyamoya disease in Japan: findings from a nationwide epidemiological survey", Stroke, 39, pp.42~47 (2008)
- Baba T, "Novel epidemiological features of Moyamoya disease", J Neurol Neurosurg Psychiatry, 79, pp.900~904 (2008)
- Kitamura K, "Moyamoya disease. in: Handbook of clinical Neurology Vol Ⅱ. 2nd ed", pp.293~306 (1989), Elsevier Science Publisher BV
- Kuroda S, "Incidence and clinical features of disease progression in adult Moyamoya disease", Stroke, 36, pp.2148~2153 (2005)
- Hallemeier CL, "Clinical features and outcome in North American adults with Moyamoya phenomenon", Stroke, 37, pp.1490~1496 (2006)
- Morioka, M, "High-risk age for rebleeding in patients with hemorrhagic Moyamoya disease: Long-term follow-up study", Neurosurgery, 52, pp.1049~1054 (2003)
- Horn P, "Arterio-embolic ischemic stroke in children with Moyamoya disease", Childs Nerv Syst, 21, pp.104~107 (2005)
- Miyakawa I, "Occlusive disease of the internal carotid arteries with vascular collaterals (Moyamoya disease) in pregnancy", Arch Gynecol, 237, pp.175~180 (1986)
- Roach ES, "Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young", Stroke, 39, pp.2644~2691 (2008)
- Fukui M, "Current state of study on Moyamoya disease in Japan", Surg Neurol, 47, pp.138~143 (1997)
- Williams DL, "Intracerebral haemorrhage and Moyamoya disease in pregnancy", Can J Anaesth, 47, pp.996~1000 (2000)
- Komiyama M, "Moyamoya Disease and pregnancy: Case report and review of th literature", Neurosurgery, 43, pp.360~368 (1998)
- 유상영, "모야모야질환이 동반된 임신 2례", 대한산부회지, 39, pp.1981~1985 (1996)
- 천민정, "중증 임신성 자간전증과 동반된 모야모야질환 1예", Korean Journal of Obstetrics and Gynecology, 45(1), pp.192~196 (2002), 대한산부인과학회