Efficacy Analysis Of Extracranial And Intracranial Vascular Bypass Grafting And Conservative Treatment For Hemorrhagic Moyamoya Disease

Objective:To compare the therapeutic effects of two clinical methods(intracranial and external vascular bypass grafting and active conservative treatment)in patients with moyamoya disease,and to discuss the appropriate treatment for blood type moyamoya disease,reduce the rate of rebleeding and mortality.Methods:From January 2008 to 2012,52 patients with blood type moyamoya disease were diagnosed by CTA or MRA or cerebrovascular angiography,all of whom were under 70 years old(18 cases in the first affiliated Hospital,13 cases in the second affiliated Hospital,13 cases in the Dalian Central Hospital).The GCS scores of 8 patients in Zhongshan Hospital affiliated to Dalian University were 8 to 13,including 11 cases of intracerebral hemorrhage(21.2%),15 cases of third ventricle hemorrhage(28.8%),21 cases of intracerebral hemorrhage breaking into the ventricle(40.4%).Among the 5 cases of subarachnoid hemorrhage(9.62%),2 cases were complicated with aneurysm,23 cases underwent craniotomy,3 cases of ventricular drainage,2 cases of embolization of intracranial aneurysm.The remaining 24 cases were treated with active hemostasis and intracranial pressure,prevention of cerebral vasospasm,etc.The vital signs were stable.After 3 months,28 cases were treated with extracranial artery bypass grafting(27 cases received superficial temporal-middle cerebral artery anastomosis and 1 case received superficial temporal-middle cerebral artery anastomosis and cerebral dural artery fusion).The ADL score at discharge was judged in the operation group,the ADL score at the discharge was recorded in the conservative group,and the activities of daily living ability(ADL)score was recorded according to the telephone follow-up for 5 years.According to the score,the patients were divided into mild dysfunction(> 60),moderate dysfunction(40 to 60)and severe dysfunction(less than 40).The causes of rebleeding and death were recorded at the same time.Results:Transcranial vascular bypass grafting can effectively reduce the rate of rebleeding and mortality of haemorrhagic moyamoya disease,improve the prognosis,facilitate the recovery of function,and improve the quality of life of patients with haemorrhagic moyamoya disease.