| Background:Moyamoya disease has a high rate of stroke, whereas the conservative treatment is not satisfactory. The present treatment for moyamoya disease mainly depends on the cerebral revascularization. For patients suffering carotid arterial stenosis or occlusion caused by atherosclerosis, the primary treatment should be drug therapy. However, some patients still suffer frequent ischemia after aggressive drug therapy, who actually can gain benefits from cerebral revascularization. Besides, the recent development in the field of microneurosurgery and neurointervention has resolved a great amount of intracranial complex aneurysms. Even so, there are still some complex aneurysms that can not be clipped or embolized successfully, and the revascularization is playing an indispensable role for those patients.Objective:To explore the clinical effect of various revascularizations in the treatment of moyamoya disease, chronic symptomatic ICA/MCA occlusion and intracranial complex aneurysms.Method:Retrospectively analyzed 99 patients who received a revascularization surgery in Qilu Hospital of Shandong University from 2013.7 to 2016.2, including 70 cases of moyamoya disease with an operation of STA-MCA bypass+encephalo-duro-myo-synangiosis(EDMS),17 cases of chronic symptomatic ICA/MCA occlusion with an operation of STA-MCA bypass, and 12 cases of intracranial complex aneurysm with individualized revascularization. And the case characters, treatment methods and perioperative complications were statistically analyzed. Also,48 cases of chronic cerebral ischemia (36 cases of moyamoya disease,12 cases of chronic symptomatic ICA/MCA occlusion) and 11 cases of intracranial complex aneurysm had finished mid-term follow-up, among which another statistical analysis was conducted in terms of patency of vascular anastomosis, change of haemodynamics and change of neurological function.Results:1. For moyamoya disease and chronic symptomatic ICA/MCA occlusion:① According to the DSA of the 48 cases after 6-12 months,44 (92%) cases shown good patency of vascular anastomosis. And 22/36 (61%) cases of moyamoya disease shown different levels of spontaneous subtemporal anastomosis with the cortical arteries.②Compared with preoperative CT perfusion examination,40/48 (83%) cases shown improved relative cerebral blood flow (rCBF),6/48 (13%) unchanged,2/48 (4%) decreased. ③No reoccurred surgery-related ischemia or hemorrhage happened among 45/48 (94%) cases. Moreover,20/48 (42%) cases encountered a decreased modified Rankin score; 25/48 (52%) cases kept a stable modified Rankin score, including 12 cases of 0 score; and 3/48 (6%) had a increased modified Rankin score.④Among 87 cases of chronic cerebral ischemia, 9 (10.3%) cases suffered perioperative complications.2. For intracranial complex aneurysm: ①According to the DSA/CTA of the 11 cases who had finished the follow-up(3-6 months),10 (91%) cases shown good patency of vascular anastomosis. ②No Residual or recurrent aneurysms were found in all follow-up cases via DSA/CTA. ③ No new neurologic deficit was found in all follow-up cases. Moreover, 7 cases encountered a decreased modified Rankin score; 2 cases kept a stable modified Rankin score; and 2 cases had a increased modified Rankin score because of the perioperative complications. ④Among 12 cases of intracranial complex aneurysm,3 (25%) cases suffered perioperative complications.Conclusion:1. STA-MCA bypass + EDMS can provide a good curative effect for adult-onset moyamoya disease, improving cerebral perfusion and neurological function, as well as preventing the reoccurrence of stroke.2. For patients of chronic symptomatic ICA/MCA occlusion with impaired haemodynamics, STA-MCA bypass can improve cerebral perfusion and neurologic function, reducing the rate of potential stroke.3. Individulized revascularization according to the location, shape and size of aneurysm is a effective treatment for intracranial complex aneurysms. |
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