Evaluation Of The Effective That 21 Cases Of Moyamoya Disease Treated By Combined Revascularization

Objective: In this study, the evaluating of the mRS (Modified Rankin Scale) to the moyamoya patients treated by combine revascularization and the comparing of hemodynamic parameters from magnetic resonance perfusion imaging scanning before and after operation were made to evaluate the effective of the surgical treatment by statistic methods, the correlation analysis of mRS and the hemodynamic parameters was made to study the application of the magnetic resonance perfusion imaging in moyamoya disease.Materials and methods: We Collected 21 cases of the moyamoya disease clinic data treated by superficial temporal artery to middle cerebral artery bypass and temprolis muscle attachment (STA-MCA Bypass + EMS) in the Department of Neurosurgery, Tongji Medical College, Huazhong University Of Science and Technology from January 1st 2006 to march 1st 2011. clinlic function were evaluated by mRS (Modified Rankin Scale) score before the operation ,after 1 week and after 3 months . GE Signa Excite 3.0T superconducting MR scanner of The United States was used for scan and the contrast agent was Gd-BOPTA (multihance), putting the resulting imagine into GE Advantage Workstation(AW4.2) for postprocessing to get the parameters of CBV ,CBF and MTT of pseudo-color picture of each selected lever. Taked the region of interest (ROI, diameter 5 mm) of the frontal lobe, temporal lobe, occipital lobe and basal ganglia, trying to select the same place each time and avoiding the infarct location and great vessels, then compared with the conference region ,to get the relative parameters such as rCBV, rCBF and MTT ,taked the data of three periods for statistic research.Results:the mRS witch before and after 1 week operation tested by Wilcoxon Signed Ranks test, Z=-1.762 and there was no significant difference between them (P<0.05,CI 95%),the same statistic methods were used to test the mRS between 1 week and 3 months after operation found there was statistic significant, Z=-4.118(P<0.05).The MRI perfusion imagine of all patients before operation showed that frontal and temporal lobe hyporperfusion in varying degrees. We found that perfusion of the frontotemporal of the operative sides improving after 1 week, but more obviously after 3 months. Each parameters mean variance analylis were performed, the results showed:the rCBF of frontal and temporal lobe increased and the MTT shortened after operation, there was no significant change of the rCBV of frontal and temperal lobe among the three times (P<0.05,CI 95%).The rCBV of occipital lobe decreased and the MTT of basal ganglia shorten after operation(P<0.05,CI 95%).The variable witch analysis of variance was significant, further LSD-test showed that there were no significant difference between the MTT of frontal lobes before and 1 week after operation(P>0.05,CI 95%) and that there was no significant difference between the rCBV of frontal lobes before and 1 week after operation(P>0.05,CI 95%),while compared with witch 3 months after operation there was significant between them(P<0.05,CI 95%). There was no difference of The occipital lobe rCBV between 1 week and 3 months after operation(P>0.05,CI 95%),but compare with before operation there was significant difference.ΔMTT temporal lobe,ΔCBF frontal lobe were grouped byΔmRS and then analyzed with analysis of variance showed that there were difference between before and after 3 months(P <0.05, CI: 95%). Spearman's correlation analysis found that the correlation coefficient r = 0.822 betweenΔMTT temporal lobe andΔmRS, (P <0.05, CI: 95%), so the temporal lobe MTT changes and clinical outcome were correlated, and there were significant difference among theΔMTT temporal lobe in each group.Conclusions: Combined revascularization could improve the symptoms of moyamoya disease patients, and magnetic resonance perfusion imaging could demonstrate the cerebral hemodynamic changes in patients before and after surgery, it could assess the treatment effectively.