Efficacy and Predictive Factors of Revascularization for Ischemic Moyamoya Disease with Encephalo-Duro-Arterio-Synangiosis Procedures
ZONG Rui;BAO Xiang-Yang;YANG Lin;et al
2011, 6(11):
852-857.
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Objective To investigate the efficacy and predictive factors of revascularization for ischemicMoyamoya disease(MMD) with encephalo-duro-arterio-synangiosis(EDAS) procedures.Methods One hundred and twenty patients with MMD admitted to our hospital were retrospectivelyreviewed. 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-occlusivelesion, grade of the posterior cerebral artery(PCA) lesion, compensation between anterior andposterior 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 theextent of revascularization.Results All the 120 patients underwent neurosurgical revascularization procedures. Since102 of them received bilateral procedures, and 18 of them received unilateral procedures. Thetotal 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%). Amultivariate 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), compensationbetween left and right hemisphere(OR =0.499, 95%CI 0.280-0.891, P =0.0188) and certaintype of infarction showed a correlation for better revascularization. Relative to normal braintissue, cortical infarction(OR =0.275, 95%CI 0.133-0.569, P =0.0005), subcortical white matterinfarction(OR=0.317, 95%CI 0.131-0.763, P =0.0104), dot-like infarction(OR=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.
