Study On The Effect Of Diifferent Extracranial-intracranial Revascularization In The Therapy Of Patients With Moyamoya Disease

ObjectiveExplore the clinical effects of different surgical extracranial-intracranial revascularization for moyamoya disease.MethodWe retrospective analysis the clinical data of 349 patients with moyamoya disease from January 2013 to September 2017 in the Department of Neurosurgery at the First Affiliated Hospital of Zhengzhou University.Including the age of onset,gender,geographical distribution,clinical manifestations,treatment methods and treatment effects.According to the patients' age,situation of extracranialintracranial vascular compensation,different treatment methods were used during the clinical treatment period.According to the surgical methods,they were divided into the superficial temporal artery-middle cerebral artery anastomosis(STA-MCA)group,STA-MCA anastomosis combined with encephalo-duro-arterio-synangiosis(STA-MCA+EDAS)group,the STA-MCA anastomosis combined with encephalo-duro-myo-synangiosis(STA-MCA+EDMS)group,encephalo-duro-myo-synangiosis(EDMS)group.Before surgery,patients accepted CT,MRI,DSA or MRA,and CT perfussion(CTP)examination,CTP was reviewed within 3 months,DSA was reviewed from within 3 months to 1 year to observe the postoperative hemodynamic changes in the brain,neonatal extracranial-intracranial vascular compensation,Postoperation complications within 1 month after surgery.All patients were followed up from three months after discharge.The neurological function and symptom improvement,hemodynamic changes,postoperative neonatal extracranial-intracranial vascular compensatory changes,and postoperative complications were compared among the four different surgical groups to evaluate the effect of different surgical treatments.Result1.Tripathi neurological assessment was performed in patients with moyamoya disease treated with five different treatment regimens 3 months after surgery or treatment.The obvious improvement rate of STA-MCA group was 73.17%;and 81.25% with STA-MCA+EDMS group;75.86% with STA-MCA+EDAS group;72.79% with EDMS group;the obvious improvement rate of conservative treatment group was 23.08%.The neurological improvement of the five groups receiving different treatment options was different(P<0.05).The significant improvement rates in neurological function after treatment in the STA-MCA group,the STA-MCA+ EDMS group,the STA-MCA+EDAS group,and the EDMS group were compared with those of the conservative treatment group,and the significant improvement rates of the postoperative symptoms in the four surgical groups were greater than that of the conservative treatment,the difference was statistically significant(P<0.0125).However,the rate of significant improvement among the four groups of patients treated with surgery,was not statistically significant(P>0.0083).2.Comparing the establishment of new collateral circulation after direct or indirect revascularization with DSA from within 3 months to 1 year after surgery,the improvement rate of STA-MCA group was 78.57%(11/14);87.50%(21/24)with STA-MCA+EDMS group;80.00%(16/20)with STA-MCA+EDAS group;76.09%(35/46)with EDMS group.For most patients who received surgical treatments,postoperative collateral circulation compensation was improved,but the improvement rate of collateral circulation among the four groups was not statistically significant(P>0.05).3.Four surgical groups of patients with moyamoya disease received CTP examination within 3 months after operation.The mean rCBF,rCBV,and MTT before and after surgery were compared using the paired t-test,For the STA-MCA group,STA-MCA+EDMS group,STA-MCA+EDAS group and EDMS group,the relative cerebral blood flow(rCBF)after operation had increased compared with preoperative,and the mean transmit time(MTT)was lower than that before surgery.The difference was statistically significant before and after operation(P<0.05).Surgical treatment was considered to have improved cerebral cortical rCBF in patients with moyamoya disease and decrease MTT in cerebral cortex blood flow.4.The postoperative complications in each surgical group included cerebral hyperperfusion syndrome(CHS),recurrent cerebral infarction,intracranial rebleeding,epilepsy,incision infection,incision nonunion and so on.For the STAMCA group,STA-MCA+EDMS group,and STA-MCA+EDAS group,the incidences of CHS within 1 month after surgery were greater than that of the EDMS group.The incidences of CHS in the direct or combined bypass groups were significantly higher than that of the EDMS group.The significance of the study(P<0.05)showed that the incidences of CHS betwween every two of the three groups were not statistically significant(P>0.0167).The incidence of cerebral infarction and the rate of cerebral hemorrhage in the four groups were compared,and the difference was not statistically significant(all P>0.0083).Conclusion1.Patients with STA-MCA,STA-MCA+EDMS,STA-MCA+EDAS,EDMS,can significantly improve postoperative neurological situation,compared with the conservative treatment group.2.Different surgical extracranial-intracranial revascularization can effectively improve the establishment of postoperative collateral circulation compensation in patients with moyamoya disease,and can improve cerebral cortical blood perfussion.3.The incidence of cerebral hyperperfusion syndrome after direct and direct combined indirect revascularization is greater than that of indirect revascularization.However,there is no difference in the incidence of cerebral infarction or cerebral hemorrhage after operation betwween each surgical group.