摘要
目的 探讨颞浅动脉-大脑中动脉搭桥+脑-硬膜-颞肌-颅骨骨膜血管融通术(STA-MCA+EDMPS)结合颅骨钻孔治疗脑膜中动脉(MMA)自发代偿的烟雾病患者的疗效.方法回顾性分析2020年8月至2021年10月航空总医院神经外科采用STA-MCA+EDMPS+额部内侧颅骨钻孔手术治疗的19例(20例侧)MMA自发代偿的烟雾病患者的临床资料(儿童3例,成人16例).术后1周行头颅CT血管成像(CTA)三维重建,以评估开颅范围及搭桥血管通畅性.术后12个月行门诊和(或)电话随访,观察手术并发症.术后每6个月进行1次头颅CT或MRI检查,以及全脑数字减影血管造影(DSA),采用松岛分级评估侧支血管生长情况.术后1周、3个月、6个月复查头颅CT灌注成像(CTP)评估脑组织血流灌注.结果 19例患者的20例侧手术均顺利完成.术后头颅CTA三维重建显示联合血管搭桥手术覆盖MCA区域,额骨钻孔位于额部内侧大脑前动脉(ACA)区域.术后1周CTA和CTP检查提示搭桥血管通畅,搭桥区域脑血流灌注较术前改善.8例术前表现为短暂性脑缺血发作(TIA)症状的患者术后TIA症状全部消失.5例成人患者术后出现过度灌注症状,经药物治疗后缓解.19例患者的随访时间为(10.2±4.2)个月(5~19个月).随访期间,所有患者均未发生缺血性或出血性卒中事件.术后12个月,9例成人患者和1例儿童患者复查全脑DSA,结果显示8例患者的8例侧STA-MCA吻合血管通畅,2例患者的2例侧搭桥血管未显影;MCA区域内,6例侧大脑半球的代偿血管为松岛分级A级(儿童1例),3例侧为B级,1例侧为C级;10例患者的烟雾血管均消失或减少;6例侧大脑半球ACA区域出现经颅骨钻孔进入额叶区域的代偿血管,均起源于眶上动脉.结论 采用STA-MCA+EDMPS结合颅骨钻孔治疗MMA自发代偿的烟雾病患者,可在不损伤已有MMA代偿血管的情况下,在额叶形成较好的旁路血管,改善额叶内侧血供,较为安全、有效.
ObjectiveTo explore the efficacy of superficial temporal artery-to-middle cerebral artery(STA-MCA)bypass with encephalo-duro-myo-pericranio-synangiosis(EDMPS)combined with ipsilateral frontal burr hole for moyamoya disease with spontaneously formed collaterals of the middle meningeal artery(MMA).Methods The clinical data of 19 patients(3 children and 16 adults)of moymoya disease affecting 20 cerebral hemispheres with spontaneously compensated MMA treated by STA-MCA+EDMPS+frontal burr hole surgery in the Department of Neurosurgery of Aviation General Hospital from August 2020 to October 2021 were retrospectively analyzed.One week after operation,three-dimensional reconstruction of head CT angiography(CTA)was performed to evaluate the scope of craniotomy and patency of bypass vessels.Outpatient and(or)telephone follow-up was conducted at 12 months post operation to observe the surgical complications.Head CT or MRI and cerebral vascular DSA(digital subtraction angiography)were performed every 6 months after operation,and the growth of collateral vessels was evaluated by Matsushima staging.CT perfusion(CTP)was re-examined at 1 week,3 months,and 6 months after operation to evaluate the brain perfusionR.esultsAll 20 operations in 19 patients were successfully completed.The postoperative three-dimensional CT reconstruction of the skull showed that the combined vascular bypass surgery covered the MCA area,and the frontal burr hole was located in the anterior cerebral artery(ACA)area of the medial frontal area.One week after operation,CTA and CTP showed that the bypass vessel was unobstructed,and the cerebral blood flow in the bypass region was improved compared with that before operation.Preoperative TIA(transient ischemic attack)symptoms of all 8 patients disappeared after operation.Five adult patients had postoperative hyperperfusion symptoms,which were relieved after drug treatment.The average follow-up time of 19 patients was 10.2±4.2 months(5-19 months).During the follow-up period,neither the children nor adults ex
作者
焦永辉
冯增伟
丁平
于俪苹
薛玲
廖先文
陈国强
韩宏彦
Jiao Yonghui;Feng Zengwei;Ding Ping;Yu Liping;Xue Ling;Liao Xianwen;Chen Guoqiang;Han Hongyan(Department of Neurosurgery,Aviation General Hospital,Beijing 100012,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2023年第5期446-450,共5页
Chinese Journal of Neurosurgery
