| Objective :(1)To summarize the epidemiology and clinical manifestation of moyamoya disease by statistics.(2)To investigate the value of CTA in the diagnosis and preoperative evaluation of moyamoya disease.(3)To establish a CTA evaluation system and a clinical prognostic evaluation system for moyamoya disease,and to investigate the value of CTA and clinical prognosis in postoperative evaluation.Methods:(1)A retrospective analysis was made of the epidemiological and clinical features of 62 cases of moyamoya disease in Second People's Hospital of Hefei and the First Affiliated Hospital of Medical University Of Anhui from June 2013 to December2016.(2)To analyze and summarize the imaging findings of moyamoya disease,and to investigate the value of CTA in the diagnosis and preoperative evaluation of moyamoya disease.(3)CTA evaluation system and clinical prognosis evaluation system were established to evaluate the effect of combined reconstructive surgery,and to explore the value of CTA and clinical prognostic evaluation system in postoperative evaluation.(4)DSA was selected as a control group to compare the difference in CTA and DSA in moyamoya disease evaluation.(5)The chi square test and U test were carried out by using SPSS17.0 statistical software,and the difference was statistically significant when P < 0.05.Results:(1)The average age of 62 adults with moyamoya disease was 39.1 + 11.5years old,the ratio of male to female was 1:1.21,and the peak incidence of female was later than that of male.1 of them have a family history;first symptoms of headache,dizziness,and accompanied by numbness or weakness,vomiting and unconsciousness.(2)Hemorrhagic MMD was most common(36 cases),the location of hemorrhage was followed by intraventricular(17 cases),brain parenchyma(16 cases)and subarachnoid space(3 cases)without pontine or cerebellar hemorrhage.Of the 26 patients with ischemic MMD,CT scan was normal in 9 cases.Only 1 of the 17 infarcts were located in the posterior circulation of occipital lobes,while the others were in the anterior circulation.(3)All patients had ICA stenosis and occlusion,12 of them were whole course lesions,58 cases involved ACA,60 cases involved MCA,21 cases involved PCA,and there was no significant difference in vascular involvement between the ischemic group and the hemorrhagic group.(4)MMD according to the progress of moyamoya vessels were divided into early,middle and late period,15 cases were early,33 cases were middle stage,14 cases were advanced,there was no significant difference between the ischemic group and the hemorrhagic group.According to the pathological changes of PCA,there were four stages: stage I 41 cases,stage II 17 cases,stage III 4 cases,stage IV 0,the difference between the ischemic group and the bleeding group was statistically significant,that is,the PCA lesion in the ischemic group was more serious than the hemorrhagic.(5)Aneurysm rupture is one of the main causes of moyamoya disease bleeding or rebleeding,7 cases of this group of patients with arterial aneurysm,including 5 cases of single and multiple in 2 cases,all located in the Willis ring;3 cases underwent clipping,1 case reduced after bilateral combined reconstruction.(6)In contrast to DSA and CTA,there was no significant difference between the assessment of stenosis,occlusion,and posterior circulation compensation;whereas DSA had an obvious advantage in assessing compensatory circulation in the lateral cervical artery.(7)The collateral circulation is divided into intracranial collateral circulation and external carotid circulation,Circulation pathway in this group of cases the most important and the most common is the posterior communicating artery-posterior cerebral artery-leptomeningeal anastomosis-cortical branches of the anterior or middle cerebral artery.(8)30 patients underwent combined reconstruction,and the others were treated with symptomatic treatment.According to the clinical prognosis evaluation system,8 cases were evaluated as excellent,18 cases were evaluated as general,and 4 cases were evaluated as poor.The postoperative CTA evaluation showed that the progression of diseased vessels was basically the same as that of the former;that is,combined reconstructive surgery can improve the clinical symptoms and delay the progress of the disease in different degrees,but it can not be cured completely.Conclusion :(1)Moyamoya disease mainly involves the end of bilateral internal carotid artery ? the anterior cerebral artery and the middle cerebral artery,even the posterior cerebral artery or the vertebrobasilar artery,It can also be unilateral lesion.The collateral circulation in the middle stages mainly depends on the circulation of the medial cranial branch.(2)In morphology,CTA can replace DSA as the most common method of examination for moyamoya disease.It can be used as a guide in the diagnosis and preoperative evaluation of moyamoya disease.(3)The CTA evaluation system and clinical prognostic evaluation system show that combined reconstruction can only improve the clinical symptoms and delay the progress of the disease,but it can not be completely cured. |
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