The Hemodynamics Of Moyamoya Disease And Clinical Efficacy Of Combined Revascularization Surgery

ObjectiveIn this study, the comparing of hemodynamic parameters from computed tomography perfusion (CTP) imaging scanning before operation of moyamoya syndrome were made to evaluate the hemodynamic changes in moyamoya disease, and the evaluating of the CTP images and the mRS (Modified Rankin Scale) to the moyamoya patients treated by combined revascularization surgery were made to evaluate the effect of the surgical treatment using statistical methods.MethodsWe collected the clinical data of20cases of moyamoya disease and moyamoya syndrome treated by superficial temporal artery to middle cerebral artery bypass and encephalomyosynangiosis (STA-MCA bypass+EMS) in the Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University from January lst2014to December31st2014. Every patient received a CTP scan before surgery, and the parameters of CBF, CBV, TTP and MTT of the AC A, MCA and PC A supply area of the brain of moyamoya syndrome patients were collected. Using statistical methods to compare the hemodynamics of the affected side with the opposite side of moyamoya syndrome patients, and compare the clinical function which was evaluated by mRS scores before the surgery,1week after surgery, and3months after surgery. Recording the complications in the perioperative period and the adverse events after discharged.ResultsThe mRS scores before the surgery,1week after surgery,3months after surgery and the hemodynamic parameters from CTP were tested by Wilcoxon signed-rank test. The CBV of the AC A and MCA supply area and the TTP of the MCA supply area is significantly higher in the affected side than the opposite side (P<0.05). The MTT of the PCA supply area is significantly lower in the affected side than the opposite side (P＜0.05). The results indicate that to the grade III-IV moyamoya disease patients, the CBF of the ACA and MCA supply area is almost stable because of the compensatory increase of the CBV. There was no significant difference between the mRS scores before and1week after surgery, but significantly lower3months after surgery, which suggests that the situation is not improved significantly1week after surgery, and longer observe is necessary to evaluate the effect of the surgical treatment.ConclusionsTo the grade III-IV moyamoya disease patients, the CBV of the ACA and MCA supply area is compensatory increased. The combined revascularization surgery is a safe and effective way to treat the moyamoya disease and moyamoya syndrome.