The Effect Of Direct Bypass Towards The Proximal Cerebral Artery In Superficial Temporal Artery-middle Cerebral Artery Anastomosis For Moyamoya Disease

Objective:To investigate the clinical effect of direct bypass towards the proximal cerebral artery in superficial temporal artery-middle cerebral artery(STA-MCA)anastomosis for moyamoya disease,and analyze the hemodynamic changes.Methods:To analyze 59 cases with moyamoya disease who operated by the same doctor in STA-MCA anastomosis.The mRS was used to evaluate the neurological function in 1 day before surgery and 3 months after surgery.And to measure the blood flow rate and direction for MCA by transcranial Doppler(TCD)in opration.The mRS in 1 day before surgery was compared with 3 months after surgery.The blood flow rate and direction were compared on each other.Results:Neurological function was improved at 3 months after surgery compared with preoperation.The mRS in 3 months after surgery was less than preoperation(P<0.05).The blood flow direction of MCA in preopreationg was all from the near MCA to the distal MCA,but in postoperation,was from the anastomosis to the proximal MCA.The blood flow rate of proximal MCA in Postoperation was higher than preoperative(P <0.05);The blood flow rate of remote MCA in Postoperation was higher than preoperative(P <0.05);The blood flow rate of proximal MCA in Postoperation was higher than remote MCA(P <0.05).Conclusions:The directiong of bypass in operation could effect on blood flow distribution at both sides of the MCA in STA-MCA bypass surgery;Towards the proximal cerebral artery in STA-MCA bypass surgery could improve the blood flow in proximal MCA and remote MCA.This method of operation could not increase the risk of vascular occlusion?new cerebral infarction and hyperperfusion syndrome.Therefore,it can be considered that the direct bypass towards the proximal cerebral artery in STA-MCA anastomosis for moyamoya disease was also safe and effective.