A Research Of In Direct And Indirect Surgery During Perioperative Period For Adult Moyamoya Disease And Relationship Between Edaravone And Cerebral Infarction

Moyamoya disease is an abnormal intracranial vascular disease with unknown etiology.The main features are the narrow and even occlusion of the end of the internal carotid artery,the anterior cerebral artery and the initial segment of the middle cerebral artery,which can be accompanied by abnormal hyperplasia of the vascular network of the skull base.The disease was first reported by Japanese scholar Suzuki in 1969,followed by cases in the whole world.But this disease is more common in East Asian countries,and there are familial aggregation characteristics.Women are more likely to be ill than men,with a proportion of about 1.8:1.Most of the natural course of the disease is progressive,and a small number of cases can stop spontaneously.There are various forms of expression,such as transient ischemic attack,cerebral hemorrhage,cerebral infarction,epileptic seizures and so on.Therefore,the moyamoya disease can be divided into four types: TIA type,cerebral infarction type,haemorrhage type and epileptic seizure type.The four types are not independent and can be converted to each other,and the damage to the central nervous system is also the result of a comprehensive impact.The disease has a great harm to the patient,which seriously affects the quality of life and even endangers life.There is a long dispute in the clinical treatment program.However,there is a basic consensus among experts and scholars in various countries for the current and internal and external bypass grafting.During perioperative period of moyamoya disease,if the patients have relatedcomplications,we should give priority to the treatment of complications and then choose an elective operation.Blood pressure should be controlled during the perioperative period.We should prevent excessive perfusion syndrome and even intracranial hemorrhage,and prevent the formation of cerebral infarction caused by local high perfusion and whole brain hypoperfusion.In the management of perioperative management,it is necessary to use the dilated cerebrovascular drugs to improve the vascular spasm caused by the operation of the bypass graft.This article is to study the relationship between the use of perioperative drugs and the recent cerebral infarction in patients.The effect of edaravone on the perioperative period of moyamoya disease was investigated by using edaravone in the perioperative period,and then comparing with the incidence of cerebral infarction in the preoperative and postoperative period.Method:1.Research object: 238 patients were selected from the Department of Neurosurgery in the Fifth Affiliated Hospital of Zhengzhou University from May2013 to February 2017 data,male to female ratio was 1:2.5,age is 20 to 65 years old(middle age 39 years old),all patients were selected after a rigorous screening,diagnosis of moyamoya disease,both preoperative and postoperative head MRI examination.According to the application of edaravone in the perioperative period,the patients were divided into 2 groups,the application group and the non-applied group.2.Supplementary Examination.Treatment group:all patients undergo MRI plus DWI,PWI,DSA examination;modified Rankin score,ultrasonic,EEG,CCAS.Control group:all patients undergo MRI plus DWI,PWI,DSA examination;modified Rankin score.3.Operation mode: 238 cases of moyamoya patients were treated with superficial temporal artery-the collateral bypass of the middle cerebral artery+temporalis-cerebral dural-vascular fusion.4.Perioperative treatment:two groups of patients treate with routine perioperativetreatment,except the two groups are different in the application of edaravone,no other relates to the different types of drugs or treatment.Edaravone is used in the treatment group: the operations begin on the 7 day after the operation.Dosage of30 mg is added to 100 ml saline intravenously,and 30 min is dripped two times a day.Control group: no drug is used.The two groups are strictly controlled by the systolic blood pressure of 140-150 mm Hg,diastolic pressure of 80-90 mmHg,the routine use of dehydration,craniofacial pressure,dilatation of cerebrovascular drugs,analgesic and hemostatic drugs.5.Evaluation method: the treatment group: 1 weeks after the operation,the head MRI plus DWI diffusion weighted imaging is performed,the skull magnetic resonance PWI perfusion weighted imaging is performed in one month,the skull DSA is rechecked 3 months after the operation,and the improved Rankin scale is performed for 6 months after the operation,and the ultrasound and electrophysiological examination are performed,and the Chinese cognitive ability scale is used to evaluate the cognitive work for 1 years after the operation.In the control group,the head MRI plus DWI diffusion weighted imaging is performed 1weeks after the operation,and the cranial magnetic resonance PWI perfusion weighted imaging is performed in January,and the skull DSA is reexamined 3 months after the operation,and the improved Rankin scale is performed for 6 months after the operation.6.Statistical method.SPSS22.0 statistical software is used to analyze the datas.Using the test to compare the qualitative data,if the expected value is <1,the exact probability method of Fisher is used,the rank sum test is used to compare the quantitative data,and the logistic risk regression model is used to calculate the OR value.The difference is statistically significant in P<0.05.ResultThe results of DSA examination after operation showed that 238 cases of bridge patients had smooth bypass vessels and reached the standard of operation.The results of cranial PWI examination in patients who have finished the operation for 1 monthswere compared with those before operation.The operative side was significantly improved compared with that before operation.There was statistical significance.The operative effect was clear,while the contralateral side was less perfusion compared with that before operation.The postoperative mRS score,ultrasonic and EEG and head DSA examination showed the effect of the operation.CCAS score promotes but there is no statistical significance.Compared with the imaging findings before and after operation,there were 28 cases of postoperative cerebral infarction,152 cases did not occur in the application group,20 cases had cerebral infarction in the non application group,and 38 cases did not occur.There were statistical differences between the two groups.Through logistic regression analysis,the results showed that there was a positive correlation between female factors,SUZUKI staging factors and cerebral infarction.P<0,05,perioperative edaravone was negatively correlated with cerebral infarction,P<0.05..Conclusion:1.In the I-IV stage of moyamoya disease in SUZUKI staging,the superficial temporal artery middle cerebral artery cortical branch bypass + temporalis myocutaneous vascular fusion can benefit,and the operative effect is good;The effect of operation on MMD in the early stage of moyamoya disease is better than that in the middle and late stages.2.MMD surgery may increase the risk of watershed infarct because of the change of intracranial hemodynamic parameters.3.The use of normal doses of Edaravone Injection in the perioperative period of MMD surgery may prevent surgical related watershed infarcts.