Assessment Of The Efficacy Of The Superficial Temporal Artery-middle Cerebral Artery Direct Bypass In The Treatment Of Adult Patients With Moyamoya Disease

Objective: Moyamoya disease is a cerebrovascular disease,which is characterized by large intracranial artery occlusion and abnormal vascular network,and seriously affects the neurological function and quality of life of patients.Genetic factors are closely related to the pathogenesis of moyamoya disease,which has a high incidence area and familial aggregation features.Medical treatment of moyamoya disease is not satisfactory,unable to control disease progression.Direct or indirect revascularization is used for the surgical treatment of moyamoya disease,which has achieved good curative effect.Among them,the superficial temporal artery –middle cerebral artery direct bypass(STA-MCA)through the bypass increases intracranial blood supply,improves the functional recovery of patients and the quality of life.This study was to understand the changes of clinical,hemodynamics and collateral circulation in patients with moyamoya disease after surgery,and to investigate the effect of STA-MCA in the treatment of adult patients with ischemic moyamoya disease,using the modified Rankin score,Karnofsky score,CT perfusion(CTP)and ASITN/SIR score.Methods:1 Choose clinical data of 24 patients with moyamoya disease,who was treated in the Department of Neurosurgery,the second hospital of he bei medical university from October 2014 to October 2015,including 14 males and 10 females,and average age was 44.71 ± 7.521.2 Inclusion Criteria: 1)Patients were older than 18 years,who were treated by STA-MCA.2)The study adopted guidelines for diagnosis and treatment of moyamoya disease in 2012 as a standard for the diagnosis and treatment.All patients were diagnosed with moyamoya disease by DSA.And bypass graft patency was confirmed by CTA at 7 days after surgery.3)The clinical symptoms were transient ischemic attack,cerebral infarction and so on.4)The follow-up time was more than or equal to 3 months,and could complete the relevant score and imaging examination.3 Patients had poor cerebral blood flow,severe intracranial compensatory deficiency,clinical symptoms.What’s more,the patient’s physical condition was allowed to undergo surgery.These were in accordance with the indications for surgical treatment of moyamoya disease.Take Y-scalp incision in the frontotemporal position after sufficient preoperative preparation,and then select the bigger one from the frontal or parietal branch of the superficial temporal artery to separate about 10 cm.The vascular anastomosis was performed between superficial temporal artery and M4 segment of middle cerebral artery which was taken as the recipient artery.4 With carrying on a face-to-face conversation,quantitative assessment of clinical symptoms in all patients was evaluated by mRS score,KPS score before surgery,at 7 days and 3 month after operation.Wilcoxon signed rank test was used for statistical results.5 The dynamic scan was performed to obtain the perfusion parameters by CT perfusion before operation,at 7 days and 3 months after operation.And then the relevant ischemic regions were designated as the region of interest.Finally,comparison between the perfusion parameters and the contralateral side resulted the relative parameter values ——relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),relative mean transit time(rMTT),relative peak time(rTTP),which were analyzed by paired t test statistically.6 ASITN / SIR score was used to analyze the DSA outcome of 24 patients with moyamoya disease before and after 3 months of operation,and the results were statistically analyzed by wilcoxon signed rank test.Results:1 mRS score and KPS score at 7 days after cerebral revascularization were compared with preoperative scores by Wilcoxon signed rank test,there was no significant difference(P> 0.05).With the same method,we found there was significant difference between mRS score、KPS score at 3 months after surgery and preoperative scores(P< 0.05).2 Compared with the preoperative data,rCBF、rCBV at 7 days after operation was increased,rMTT was reduced,there are differences significantly(P<0.05).On the contrary,the result of comparison of preoperative and postoperative 7 days of rTTP had no obvious change(P>0.05).The differences of rCBF,rCBV,rMTT and rTTP were statistically significant between the preoperative and postoperative 3 months.(P<0.05).3 Wilcoxon signed rank test was performed in all patients before and after operation with ASITN/SIR score,and the difference was statistically significant.(P < 0.05).Conclusions:1 STA-MCA improves the clinical symptoms and quality of life what mRS score and KPS score reflects,promotes the compensatory collateral circulation in ischemic area of moyamoya disease patients,relieves the state of intracranial ischemia.2 CT perfusion can better evaluate moyamoya disease in patients with hemodynamic change.And cerebral angiography can be a more comprehensive assessment of collateral circulation in patients with moyamoya disease change.