| Objective: The collateral circulation in patients with moyamoya disease（MMD）plays a key role in compensating for cerebral ischemia,but there are few reports.The influence of MMD collateral circulation status on the complications and prognosis after STA-MCA bypass is not clear.Therefore,we carried out this study to explore the surgical efficacy of STA-MCA bypass in adult MMD patients and clarify the relationship between collateral circulation classification and postoperative complications and surgical efficacy.Methods: The clinical data of adult MMD patients who underwent neurosurgery in Jining First People ’s Hospital from October 2016 to December 2021 were retrospectively analyzed.The preoperative clinical features,imaging features and all postoperative complications（including transient hyperperfusion syndrome）before discharge were recorded.The collateral circulation classification was evaluated by DSA.The data of patients during follow-up were collected,including modified Rankin scale（m RS）score and Glasgow outcome scale（GOS）.Through correlation analysis,the correlation between collateral circulation classification and the severity of clinical symptoms,postoperative complications and surgical efficacy was found.in Jining and surrounding areas were included in this study.There were46（41%）males and 67（59%）females,with a male to female ratio of1:1.45,a minimum age of 19 years,a maximum age of 68 years,a mean age of（48.3±10.7）years,and a median age of 48 years.The number of patients in the age group of 43-48 years was the largest,with a unimodal distribution.The top three regions in terms of number of patients were Rencheng,Wenshang and Jiaxiang counties,with no significant differences in regional distribution.There were 38 cases（29.2%）of postoperative complications（including transient hyperperfusion syndrome）,including 9 cases（6.9%）of new postoperative cerebral infarction,2 cases（1.5%）of new cerebral hemorrhage,22 cases（16.9%）of hyperperfusion syndrome,5 cases（3.8%）of poor trauma healing,and2 cases（1.3%）of subdural effusion.The m RS score at follow-up was better than that at admission,and there was a significant difference between the two comparisons（Z=6.09,P<0.01）.The prognosis of patients at follow-up was better,with 84.6% of m RS scores 0-2 and 96% of GOS scores 4-5,and there were no deaths.There was a significant correlation between symptomatic lateral branch circulation grading and m RS score at admission（P < 0.05）and m RS score at follow-up（P < 0.01）,with a negative correlation.There was a significant correlation between surgical lateral branch circulation score ≤4 and postoperative hyperperfusion syndrome（P < 0.01）.There was a significant correlation between surgicalResults: A total of 113 patients with MMD（130 lateral hemispheres）collateral circulation grading and the presence of postoperative complications（P < 0.01）,new cerebral infarction in the perioperative period（P < 0.05）and GOS score at follow-up（P < 0.05）.Conclusion: 1.Our study shows that the majority of adult MMD patients in Jining and surrounding areas are 43-48 years old.The top three areas of the number of patients were Rencheng District,Wenshang County,Jiaxiang County,and there was no significant difference in the distribution between counties.2.Symptom side cerebral hemisphere collateral circulation classification of MMD patients was significantly associated with neurological status.In patients undergoing STA-MCA bypass,the classification of cerebral hemisphere collateral circulation on the surgical side was significantly correlated with postoperative complications,perioperative new cerebral infarction and surgical prognosis.3.Operation side cerebral hemisphere collateral circulation score ≤ 4points,STA-MCA bypass after the occurrence of high perfusion syndrome probability.Therefore,MMD patients with low preoperative collateral circulation grade are prone to postoperative cerebral ischemia and hyperperfusion syndrome,which should be treated carefully during perioperative period. |
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