A Comparative Study Of Different Surgical Treatments For Adult Moyamoya Disease

Objective To compare the clinical effects and safety of superficial temporal artery-middle cerebral artery bypass combined with superficial temporal artery branch sticking and Encephalo-duro-myo-synangiosis in the treatment of adult moyamoya disease,and to discuss the best surgical treatment for adult moyamoya disease.Methods The clinical data of 118 adult patients with moyamoya disease,who underwent Surgical revascularization(unilateral)in the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from August 2011 to May 2016,were analyzed retrospectively,including superficial temporal artery-middle cerebral artery(STA-MCA)bypass combined with superficial temporal artery branch sticking(combiend bypass surgery,CBS)in 51 cases(CBSgroup),encephalo-duro-myosynangiosis in 67 cases(EDMS group).The postoperative complication rate,Symptom remission rate and CTP hemodynamic parameter change rate(<Postoperative 3 months),Symptom remission rate,rebleeding rate,recurrence rate,vascular remodeling rate and CTP hemodynamic parameter change rate(≥Postoperative 3 months)of two groups were compared.The follow-up time was 3months ~67 months,with an average of 22.3 ±2.1months.The independent samples t-test,corrected t-test,paired t-test or nonparametric Wilcoxon test was used for comparison of continuous data between groups,and the chi-square test,Kruskal-Wallis rank sum test or Yates’ correction was used for comparison of categorical data between groups,with P< 0.05 for the difference was statistically significant.Results1.The incidence of postoperative complications in the CBS group(33.3%,17/51)was higher than that in the EDMS group(13.4%,9/67),which was mainly manifested as cerebral hyperperfusion syndrome(CHS).The difference was statistically significant(χ~2=6.676,P<0.05);2.The symptom remission rate of CBS group(86.3%)was higher than that of EDMS group(40.3%)in the early postoperative period.The difference was statistically significant(H=31.199,P<0.05);3.CTP related parameter changes: in group CBS,CBF and r CBF were increased,TTP and r TTP were shorter in the short term than that before operation.The difference was statistically significant(P<0.05);CBV,and r CBV decreased compared with preoperative.The difference was not statistically significant(P>0.05);In group EDMS,CBF and r CBF increased,in the short term after operation,and CBV,r CBV decreased compared with preoperative.The difference was not statistically significant(P>0.05);TTP and r TTP were shorter than preoperative.The difference was statistically significant(P<0.05);In the early postoperative period,CBF and r CBF increased significantly in CBS group compared with EDMS group.The difference was statistically significant(P<0.05);In the late postoperative period,the average CBF in the CBS group was higher than that in the EDMS group.The difference was statistically significant(P<0.05).4.The remission rate of CBS group(92.2%)was higher than that of group EDMS(79.1%)in the late postoperative period.The difference was statistically significant(P<0.05).5.The postoperative rebleeding rate in group CBS(5.9%)was lower than that in group EDMS(9%).The difference was not statistically significant(χ~2=0.074,P>0.05);The postoperative rebleeding rate in group CBS(6.7%)was lower than that in group EDMS(12.2%)for hemorrhagic MMD.The difference was not statistically significant(χ~2=0.136,P>0.05);6.The ischemia reperfusion rate in group CBS(4.8%)was lower than that in group EDMS(11.5%)for Ischemic MMD.The difference was not statistically significant(χ~2=0.091,P>0.05);7.The effective rate of postoperative revascularization in the CBS group(92.2%)was higher than that in the EDMS group(61.2%).The difference was statistically significant(H=20.705,P<0.05).8.In the CBS group,3 cases were not treated with peripheral aneurysms,and the other 2 cases disappeared,and the other 1 cases were smaller than before operation.In the EDMS group,2 cases were not treated with peripheral aneurysms,and all of them disappeared after DSA scan.Conclusion1.The application of superficial temporal artery-middle cerebral artery bypass combined with superficial temporal artery branch sticking and Encephaloduro-myo-synangiosisare are effective surgical methods for the treatment of adult patients with moyamoya disease;2.The effect of superficial temporal artery-middle cerebral artery bypass combined with superficial temporal artery branch sticking on the treatment of adult ischemic moyamoya disease is more accurate,with rapid relief of symptoms and the remission rate of cerebral perfusion was improved obviously,the advantage of high effective rate of vascular reconstruction;3.Treatment of hemorrhagic MMD is still not sure which kind of operation is more effective,combiend bypass surgery may be beneficial for patients with moyamoya disease,further study is needed;4.The incidence of postoperative complications in group CBS was higher than that in group EDMS,and the cerebral hyperperfusion syndrome was the most common complication after CBS.