摘要
Abstract
Objective To investigate the efficacy and predictive factors of revascularization for ischemic Moyamoya disease(MMD) with encephalo-duro-arterio-synangiosis(EDAS) procedures. Methods One hundred and twenty patients with MMD admitted to our hospital were retrospectively reviewed. Clinical factors including gender, age at first operation, cerebral glucose metabolism, type of infarction, surgical side, stage of the internal carotid artery(ICA) bifurcation steno-occlusive lesion, grade of the posterior cerebral artery(PCA) lesion, compensation between anterior and posterior circulation, compensation between left and right hemisphere were retrospectively gathered. We used the logistic regression model to estimate the impact of preoperative clinical factors on the extent of revascularization.Results All the 120 patients underwent neurosurgical revascularization procedures. Since 102 of them received bilateral procedures, and 18 of them received unilateral procedures. The total procedures performed were 222. Collateral formation in the middle cerebral artery(MCA) territory from superficial temporal artery(STA) was seen in 174 hemispheres(78.38%). A multivariate logistic regression analysis of age at first surgery(OR=1.030, 95%CI 1.012-1.049, P=0.0011), grade of the PCA lesion(OR=0.767, 95%CI 0.601-0.977, ,P=0.0319), compensation between left and right hemisphere(OR=0.499, 95%CI 0.280-0.891, P=0.0188) and certain type of infarction showed a correlation for better revascularization. Relative to normal brain tissue, cortical infarction(OR=0.275, 95%C/0.133-0.569, P=0.0005), subcortical white matter infarction(OR=0.317, 95%CI 0.131-0.763, P=0104), dot-like infarction(OK=0.392, 95%CI 0.193-0.796, p=0.0096) showed better revascularization.Conclusion Surgical treatment with EDAS is effective at establishing extra-intracranialrevascularization. Patients with lower preoperative age, higher grade of the PCA, appearance ofcompensation between left and right circulation showed better revascularization. Relative to normalbrain, MMD have ischemic lesions involving the cortical, subcortical and dot-like will get betterrevascularization results.关键词
脑底异常血管网病/脑血管重建术/脑硬脑膜动脉血管融通术/搭桥手术Key words
Moyamoya disease/ Cerebral revascularization/ Encephalo-duro-arteriosynangiosis/ Bypass surgery
