关键词: 烟雾病; 皮质微血管密度; 脑-硬脑膜-动脉血管融通术; 联合血管重建术

Abstract:

【Abstract】 Objective To compare the efficacy of encephalo-duro-arterio-synangiosis (EDAS) and combined bypass surgery (CBS) for adult moyamoya disease patients with low cortical microvascular density. Methods A prospective study was conducted. Collect the data of 50 hemispheres who had been performed combined bypass surgery (CBS group). These adult patients with moyamoya disease had low cortical microvascular density and admitted to 307 Hospital of Chinese People's Liberation Army from Jun 2009 to Aug 2012. The control group was 37 hemispheres of low cortical microvascular density patients treated with EDAS from Nov 2002 to Nov 2008 (EDAS group). All patients in the CBS group were performed with unilateral or bilateral EDAS and superficial temporal artery-middle cerebral artery (STA-MCA) branch anastomosis combined surgery. Analyse the cortical microvascular density according to the cortical photo, and determine the operation method. The improvement of cerebral blood flow was evaluated by transcranial Doppler (TCD),and postoperative revascularization was evaluated by digital substraction angiography (DSA). Results In the EDAS group, the mean flow velocity of superficial temporal artery (STA Vm) increased obviously after operation ([42.18±12.68] cm/s vs [28.34±7.28] cm/s, P=0.041). The pulsation index (PI) of STA obviously declined after operation ([1.62±0.62] vs [2.42±0.87], P=0.043). In the CBS group, the STA Vm increased obviously after operation ([53.67±11.48] cm/s vs [26.83±8.46] cm/s, P=0.032). The STA PI obviously declined after operation ([1.24±0.58] vs [2.61±0.91], P=0.039). After 6 months, the STA Vm of the CBS group were higher than that of the EDAS group ([53.67±11.48] vs [42.18±12.68], P=0.042), the STA PI of the CBS group were lower than that of the EDAS group ([1.24±0.58] vs [1.62±0.62], P=0.047). In the postoperative revascularization assessment, the hemispheres that reached grade II in the CBS group was more than the EDAS group (48% vs 37.8%, P=0.033). Conclusion For low cortical microvascular density of adult patients with moyamoya disease, both EDAS and CBS can improve the cerebral blood flow and surgery vascular remodeling, but CBS is better than EDAS. So for low cortical microvascular density of adult patients with moyamoya disease, we can take CBS in order to further improve the prognosis of patients.

Key words: Moyamoya disease; Cortical microvascular density; Encephalo-duro-arterio-synangiosis; Combined bypass surgery