Clinical Analysis Of Curative Effect Of Extracranial-Intracranial Bypass For Ischemic Moyamoya Disease

Objective Inquiry into thecurative effect of extracranial-intracranial bypass for ischemic moyamoya disease.Methods Retrospective analysis the clinical data of 197 cases of ischemic moyamoya disease patient who are treated in the first affiliated Hospital of Zhengzhou University Neurosurgery from June 2012 to June 2015. In view of the age and the situation of cranial vascular both inside and outside of patients decided whether have the brain vascular reconstruction operation. According to the methods of treatment,it is divided into superficial temporal artery-middle cerebral artery anastomosis combining with encephalo-duro-myo-synangiosis(STA-MCA+EDMS) group, and encephalo-duro-myo-synangiosis(EDMS) group, multiple burr hole(MBH) group, and conservative treatment group. Routine check for patients before surgery, such as CT and MRI and CT Perfusion imaging and DSA imaging analysis. Be reviewed or telephone follow-up when dischargedafter6 months. Compare the clinical improvement of symptoms, regional cerebral blood flow dynamics, DSA manifestation and complication rates before and after surgery of the three groups which conducted the extracranial-intracranial bypass before and after operation.Results 1. The improvement of neurological deficits when discharged after 6 months of three surgical groups are better than the conservative treatment group, the differencewas statisticallysignificant(P<0.0083). The proportion of obviously neurological deficits improvement of STA-MCA+EDMS Group(88.57%) is slightly better than the EDMS Group(80%) and MBH Group(74.07%), The proportion of obviously neurological deficits improvement of EDMS Group(80%) is slightly better than the MBH Group(74.07%). But the multiple comparisondifference of STA-MCA+EDMS group, EDMS group and MBH group did not reach statisticallysignificant(P>0. 05). 2. The new collateral vascular reconstruction effect of 48 patients with moyamoya disease were compared. In STA-MCA+EDMS group,9 cases were effective,1 case is not valid, the DSA performs well in 6 cases, generally in 3 cases, poor performance in 1 case, the effective rate is 90%. In EDMS group,25 cases were effective, 5 case is not valid, the DSA performs well in 17 cases, generally in 8 cases, poor performance in 5 cases, the effective rate is 83.33%. In MBH group,6 cases were effective, 2 case is not valid, the DSA performs well in 3cases, generally in 3 cases, poor performance in 2 cases, the effective rate is 75%. The effective rate of SAT-MCA+EDMS(90%), slightly higher than the EDMS(83.33%) and MBH(75%). But three groups of DSA performance difference was not statistically significant(P>0. 05)? 3. 20 moyamoya disease patients which were conducted CTP examination before and after surgery were compared. The postoperative r CBV and r CBF of the 20 cases increase compared to preoperative, The postoperative MTT and TTP are shortened than before surgery. The difference between the postoperative r CBF r CBV, MTT and TTP parameter values and the preoperative ones wasstatisticallysignificant(P<0.05). 4. the postoperative complications within 10 days included transient deterioration of neurological function, epilepsy, patients with acute cerebral infarction and(or) subdural hematomas, swelling of the temporalis muscle flap incarcerated. STA-MCA+EDMS group 8 cases(22.86%), EDMS group 19 cases(20.00%), MBH group 2 cases(3.7%). The postoperative complication rate of MBH group was significantly lower than the STA-MCA+EDMS group and the EDMS group; Comparing these three groups using chi-square test, the difference has not statistically significant(P>0. 05). 5. 24 children cases for indirect revascularization, 98 cases in adults. children neurologic improvement rating: excellent in 20 cases, good in 4 cases, generally in 1 cases, poor in 0 case; adult neurological improvement rating: excellent in 52 cases, good in 20 cases,generally in 11 cases, poor in 14 cases. The clinical improvement of children and adult groups using contingency tables ?2 statistical comparison, there was a statistically significant difference(P<0.05). 38 cases were reviewed with DSA after half year, children in 16 cases, adults in 22 cases. DSA performed well in 14 cases of children, generally in 2 cases,poor performance 0 case; adult group DSA performs well in 12 cases, generally in 3 cases, poor performance in 7 cases. The new collateral vessels on DSA of children and adult discharged indirect revascularization using Fisher exact probability statistics, there was a statistically significant difference(P<0.05).Conclusions 1. Surgical treatment for ischemic moyamoya disease is better than medicine therapy, extracranial-intracranial bypass can significantly improve cerebral blood flow perfusion and cerebral function; 2. Three kinds of extracranial-intracranial bypass in the treatment of ischemic moyamoya disease has a significant effect, The difference of the effect after operation for half a year is not significant; 3. The difference of the security of three kinds of extracranial-intracranial bypass was not significant, Preoperative assessment, select the operation indication accurately, perioperative management and around the time of anesthesia management is very important for prevention of complications; 4. The effect of indirect extracranial-intracranial bypass for children ischemic moyamoya disease is better than the one for adults.