Therapeutic Effect Of The Superficial Temporal Artery-middle Cerebral Artery Bypass On Adult Patients With Ischemic Moyamoya

Objective:Moyamoya disease is a rare type of cerebrovascular disease.Its characteristic pathological appearance is the gradual stenosis of the internal carotid artery,causing a progressive decline in cerebral blood flow,and compensating large amounts of abnormal hyperplasia from the skull base Pathological vascular network and the formation of collateral circulation.The ultimate outcome of moyamoya disease is the complete occlusion of the internal carotid artery,which is ultimately provided by the external carotid or vertebral arteries.The etiology and pathogenesis of moyamoya disease is still not clear,the risk factors may be due to congenital factors or the combined effect of natural and acquired factors.Among them,adult-onset moyamoya disease mainly manifests as headache,dizziness,epilepsy,numbness of limbs,slurred speech,mental changes and cerebral infarction,which eventually leads to the permanent loss of neurological function and organ dysfunction,leading to serious adverse prognosis.Currently with the widespread use of noninvasive vascular imaging,many patients with conventional physical examination or just because of headaches,dizziness and outpatient clinic after diagnosis was diagnosed with ischemic moyamoya disease.The current clinical treatment of ischemic moyamoya disease,including surgical treatment and medical treatment,the ultimate goal is to maximize the supply of cerebral blood flow to ensure the quality of life of patients and prevent the occurrence of acute stroke events.Medical treatment of ischemic moyamoya mainly symptomatic supportive treatment strategies,no special and effective method,and even some scholars believe that drug treatment may be ineffective.Surgical treatment mainly revascularizations,including direct bypass,indirect bypass and combined bypass,postoperative patients can increase cerebral blood flow,the establishment of effective collateral circulation,the final patient's clinical symptoms and quality of life improved.Currently the most common direct revascularization is the superficial temporalartery-middle cerebral artery bypass graft(STA-MCA).In this study,the clinical symptoms,hemodynamics and quality of life of patients with ischemic moyamoya disease before and after STA-MCA were mainly evaluated in order to evaluate the effect of STA-MCA on adult patients with moyamoya disease.The evaluation methods included Computed Tomography Perfusion imaging(CTP),Modified Rankin Scale(MRS),Modified Barthel Index(MBI)Materials and Methods:1.From October 2015 to October 2017,the clinical data of 19 patients with Ischemic moyamoya disease attending neurosurgery in The First Affiliated Hospital of Dalian Medical University were selected,including 11 males and 8 females,The average age is 42.35 ± 8.13 years old.2.Inclusion criteria:(1)age ? 18 years old;(2)According to the 2012 Japan guidelines for the diagnosis of moyamoya disease,patients underwent digital subtraction angiography,magnetic resonance angiography,CT angiography(3)all patients underwent head CT except intracerebral hemorrhage;(4)the clinical manifestations of patients were transient ischemic attack(TIA),cerebral infarction,limb movement disorders,epilepsy and other ischemic symptoms;(5)Postoperative follow-up ? 3 months to complete the relevant score.The patients were enrolled in the first day,one week after surgery,three months after surgery using the MRS score and MBI score for clinical symptoms,the ability to quantify the score of voluntary activity,and the data obtained using the Wilcoxon signed rank test.Computed Tomography Perfusion imaging(CTP)was performed on the patients before surgery,one week after surgery,and three months after surgery respectively to obtain the corresponding data.The purpose of this study was to compare the preoperative and postoperative hemispheric Hemodynamic assessment of the effect of surgery.Therefore,after communicating with the imaging physician,the ischemic area of ??the patient's hemisphere was chosen as the region of interest,and the relative parameters such as relative cerebral blood volume(rCBV),relative brain Blood flow(r CBF),relative mean time(r MTT),relative peak time(r TTP).The data obtained after the comparison paired t-test,P <0.05 was considered statistically significant.statistical results:The results of one-week postoperative MRS and MBI scores of all patients were statistically not statistically significant(P> 0.05)by using Wilcoxon signed-rank test and preoperative MRS score and MBI score.After three months,the patients were again collected MRS and MBI scores and preoperative score test results showed that there was a statistically significant difference(P <0.05).The rCBF and rCBV of one week after operation were significantly higher than those before operation(P <0.05),but there was no significant change of rTTP(P> 0.05).There was no statistical significance.There were significant differences in rCBF,rCBV,r MTT and rTTP after operation between the two groups(P <0.05).Conclusion:Temporal superficial artery-middle cerebral artery bypass graft can effectively improve the clinical symptoms and quality of life of patients with ischemic moyamoya disease,and alleviate the situation of intracranial ischemia by promoting hemodynamics in the ischemic area.