Effect Of Direct And Indirect Bypass Grafting On Moyamoya Disease

Background and purpose Moyamoya disease is a kind of disease with high disability rate and mortality.It is characterized by the increase of the thickness of the distal intravascular mucosa of the internal carotid artery and the increase of the thickness of the anterior cerebral artery and the middle cerebral artery,resulting in a sharp decrease or interruption of blood flow.Extracranial and extracranial vascular bypass grafting is a surgical treatment for moyamoya disease,including direct bypass grafting and indirect bypass grafting.However,which bypass surgery is more effective in the treatment of moyamoya disease and more effective in the improvement of cerebral blood perfusion,these problems are not supported by enough persuasion.This topic passes through the The cases of moyamoya disease bypass surgery were analyzed systematically and retrospectively.the therapeutic effects of direct bypass grafting and indirect bypass grafting were compared in order to guide the choice of' clinical surgical treatment and to provide auxiliary suggestions for the treatment of clinical moyamoya disease.Methods Retrospective analysis from September 2016 to January 201 8,subject study into the group of Shenyang and within the scope of Dalian including Dalian City Central Hospital,Dalian Medical University affiliated to the second Hospital,Shenyang military region General Hospital Neurosurgery 120 patients who had been bypass surgery.The patients were divided into ischemic group and bleeding group,and two subgroups were divided into direct bypass group and indirect bypass group by the difference of direct and indirect bypass operation mode in each group.The patients were evaluated for blood flow reconstruction,improvement of nerve function,recurrence of postoperative stroke and improvement of clinical symptoms.To evaluate the clinical prognosis of two kinds of moyamoya disease bypass surgery.Among them,the revascularization after bypass grafting was considered by the change of Suzuki stage of cerebral angiography before and after operation,and the improved RANKIN scale(mRS score)was used to evaluate the daily living ability of the patients before and after operation.By comparing the mRS score before and after operation,the score improvement difference of each patient was calculated as a relatively objective quantitative evaluation index.The recurrence of stroke after operation by recording the recurrence time,the type of onset and the shadow of recurrence to the original condition.The response was assessed;and the improvement in clinical symptoms was assessed by comparing the change in the most important neurological impairment symptoms before and after the patient's operation.The statistical correlation was performed with the SPSS 20.0 statistical software,and the difference of the diagnosis and treatment effect of the patients with the smoke was selected by the combination of the two methods of direct and indirect operationResults The Suzuki stage of patients with ischemic and hemorrhagic moyamoya disease after bypass grafting was improved,which proved that bypass grafting was effective and vascular bypass grafting was successful.the statistical results showed that the success rate of blood flow reconstruction in direct bypass grafting group was higher than that in indirect bypass grafting group,and there was significant difference between the two groups(P<0.05)In terms of neurological function,there was significant difference in the improvement of nerve function between the direct bypass operation group and the indirect bypass operation group(P<0.05),but there was no significant difference between the direct bypass operation group and the indirect bypass operation group(P>0.05).There was no significant difference in the recurrence of cerebral apoplexy between the two methods(P>0.05),but the risk of recurrent cerebral hemorrhage after direct bypass surgery was significantly lower than that of indirect bypass surgery(P>0.05).in that aspect of clinical symptom,the improvement of the clinical symptom of the direct bypass operation group of the ischemic-type smoke patient is better than that of the indirect bypass operation group and the analysis is statistically different(P<0.05),However.there was no statistical difference between the direct bypass operation group and the indirect bypass operation group(P>0.05).Conclusion 1.The two bypass grafting methods are effective in the treatment of ischemic and hemorrhagic moyamoya disease after operation,and the vascular bypass grafting is successful,but the direct bypass operation group has higher success rate of blood flow reconstruction after bypass grafting than the indirect bypass operation group,and the ability to establish effective collateral circulation is stronger.2.For ischemic moyamoya disease,direct bypass surgery has more practical significance than indirect bypass surgery in the improvement of nerve function,and the effect is obviously better than the latter,but there is no significant difference between direct bypass surgery and indirect bypass surgery in patients with hemorrhagic moyamoya disease.3.There was no significant difference between the two methods in preventing recurrence of cerebral apoplexy after moyamoya disease treatment,but through case analysis,it was found that the risk of recurrent cerebral hemorrhage after direct bypass surgery was significantly lower than that after indirect bypass surgery,but further clinical analysis of large data was needed to confirm it..4.The improvement of the clinical symptoms in the direct bypass operation group was better than that of the indirect bypass operation group,but there was no difference between the direct bypass operation group and the indirect bypass operation group.