| ObjectiveTo analyze the clinical, angiographic features and treatment of hemorrhagic moyamoya patients with the posterior circulation involvement(PCI).MethodsThere were 57 patients with the PCI and 167 patients without PCI among the 224 hemorrhagic patients before or after revasculariztion from December 2002 to December 2011,whose clinical and imaging data was analyzed retrospectively.The age,sex,the type of hemorrhage,the internal carotid artery(ICA) Suzuki stage and the unusual artery in the bleeding hemisphere of the 224 hemorrhagic patients were statistical analysed,and the laterality in the ICA stages and in the posterior cerebral artery(PCA) stages and the effect of surgery of the 57 hemorrhagic patients with the PCI were statistical analysed.Results1.The 224 bleeding patients accounted for 14.24% of the patients with moyamoya disease were treated during this period, and 57(25.45%) patients were with PCI.The male and female ratio of patients with PCI was 1:1.71,in which 21 patients were males and 36 patients were females.The average age was 33.49±9.56 years old,which was 13 to 56 years old,when patients hospitalized.The male and female ratio of patients without PCI was 1:1.09,in which 80 patients were males and 87 patients were females.The average age was 34.52±10.43 years old,which was 1 to 57 years old,when patients hospitalized.There was no significant statistical difference in sex(P > 0.05) and age(P > 0.05) distribution about the PCI.2.Among 224 patients, 85 patients were in the intraventricular hemorrhage,34 patients were in the subarachnoid hemorrhage,105 patients were of Parenchymal hemorrhage, in which 25 cases of thalamic hemorrhage is,44 cases of basal ganglia hemorrhage is,and 36 cases are with cerebral hemorrhage.The number of patients withPCI in the intraventricular hemorrhage was 22,and the number of patients with PCI in the subarachnoid hemorrhage was 8,the number of patients with PCI in the thalamic hemorrhage was 25,the number of patients with PCI in the basal ganglia hemorrhage was 2,the number of patients with PCI in the cerebral hemorrhage was 0.The number of patients without PCI in the intraventricular hemorrhage was 63,and the number of patients without PCI in the subarachnoid hemorrhage was 26,the number of patients without PCI in the thalamic hemorrhage was 0,the number of patients with PCI in the basal ganglia hemorrhage was 42,the number of patients with PCI in the cerebral hemorrhage was 36.The most hemorrhage type of patients with PCI was the thalamus hemorrhage(43.86%) and the second was the ventricular hemorrhage(38.60%).And the incidence rate of thalamic hemorrhage in the patients with PCI is higher than the rate in the patients without PCI(P<0.05).3.According to Suzuki stage, in 57 patients with PCI,the Ⅲ to VI stage Was in 3,7,24,23 cases respectively.And the Suzuki stage of 57 patients with PCI in the Ⅴ(42.1%)and Ⅵ(40.4%)was in a high proportion.In the other 167 patients,the I to VI stage Was in0,30,52,70,7,8 cases respectively,according to Suzuki stage.And the stage of patients without PCI in theⅢ(31.1%)and Ⅳ(41.9%)was in a high proportion.The two groups had the statistical difference(P<0.01) in the Suzuki stage.4.Lateralities in both Suzuki and PCA lesions were found in 24 patients,whose brain circulation was compared the left and right side. In 20(83.33%) of the 24 patients, the more advanced side of Suzuki lesions was the same as that of PCA lesions, while it was contralateral in 4 patients(16.67%).Lesions with more advanced Suzuki and PCA stages were on the same side, with significant probability(P<0.01).5.Among 57 patients with PCI,as to the bleeding hemisphere,11 patients showed the dilation of anterior choroidal artery,21 patients showed the patency of posterior communicating artery,47 patients showed the dilation of posterior choroidal artery,45 patients showed the patency of posterior pericallosal artery;Among 167 patients without PCI,as to the bleeding hemisphere,61 patients showed the dilation of anterior choroidal artery,115 patients showed the patency of posterior communicating artery,5patients showed the dilation of posterior choroidal artery,134 patients showed the patency of posterior pericallosal artery.The two groups had the statistical difference(P<0.01) in the abnormal artery.As to the bleeding hemisphere, the number of patients with dilation of posterior choroidal artery and patency of posterior pericallosal artery was in a high proportion,among patients with PCI.And the numberof patients with patency of posterior communicating artery was in a low proportion,among patients with PCI.The two groups had no statistical difference(P=0.833) in the patency of posterior pericallosal artery.The occurrence rate of dilation of posterior choroidal artery in the patients with PCI was higher than the rate of patients without PCI(P<0.01).The occurrence rate of dilation of anterior choroidal artery in the patients with PCI was lower than the rate of patients without PCI(P=0.016).6.Among 57 patients with PCI, there was only one patient who had been operated as unilateral brain encephalo-duro-arterio-synangiosis(EDAS) and unilateral brain superficial temporal-middle-cerebral artery(STA-MCA)and brain occipital EDAS.There are 41 patiengts under the bilateral EDAS and 4 patients under unilateral EDAS.9 patients accepted the bilateral EDAS and occipital EDAS.2 patients were no treated by operation.7.The average time of median follow-up after surgery(n=53) was35.8months(rangefrom8 to 102months).Four patients had no accepted the median follow-up after surgery.Two patients were no treated by operation,and one patient accepted the bilateral EDAS,and one patient accepted the unilateral EDAS.According to the m RS,the number of 0 to 6 grade Was 10, 18, 8, 2, 2, 0, 0, in the preoperative 40 patients accepted the bilateral EDAS.And,the number of 0 to 6 grade Was 18, 12, 6, 1,1, 1, 1,in the postoperative 40 patients accepted the bilateral EDAS.There was significant statistical difference between the preoperative m RS scores and the postoperative m RS scores.Two(5.0%) patients suffered an episode of rebleeding.ConclusionThe hemorrhagic moyamoya with PCI is not uncommon,which in adult women is relatively rare.The Suzuki stage was more than in the V or VI stage,and lesions with more advanced Suzuki and PCA stages were on the same side.The rato of the thalamus hemorrhage and ventricular hemorrhage was in a high proporion. 4.The main reason of hemorrhage may be the rupture of posterior choroidal and thalamoperforate artery.The surgical treatment effect was excellent and good on the whole,and The surgical treatment effect of occipital operation was more excellent in this study. |
PDF Full Text Request