| Objective: To analyze the clinical features of adult moyamoya disease(MMD)patients with cerebral aneurysm and the prognosis of patients receiving different treatments,in order to explore the choice of surgical methods.Methods: The clinical data of 642 patients with MMD who met the diagnosis and were admitted to the Second Affiliated Hospital of Nanchang University from June 2011 to December 2019 were retrospectively analyzed.By analyzing the surgical status and postoperative prognosis of aneurysms under different treatment methods,the appropriate treatment methods for MMD complicated with intracranial aneurysms were preliminarily discussed.Results:(1)Of the 642 patients with MMD,46(7.2%)had intracranial aneurysm.In terms of location,there were more main aneurysms(64%)and more anterior aneurysms(60%).(2)There were no significant differences in gender(P=0.427),age(P =0.653),history of hypertension(P =0.727),history of diabetes(P=0.327),smoking history(P =0.486),unilateral and bilateral(P =0.080)and stage(P=0.397)of MMD and admission MRS score(P=0.194)between MMD patients with and without aneurysm.However,MMD patients had a higher incidence of bleeding after aneurysm(OR=2.18,95%CI:1.063-4.485),and the difference was statistically significant(x~2=4.718,P <0.05).(3)The choice of surgical treatment or conservative treatment was related to the clinical manifestations of the patients(x~2=7.622,P<0.05),and not related to the location of aneurysm(P >0.05).Compared with the conservative treatment group,the surgical group had a higher rate of good prognosis,but a lower rate of poor prognosis and a lower mortality(Z=-2.056,P <0.05).(4)The patients with MMD complicated with main aneurysm received endovascular embolization +Ⅱ stage revascularization or craniotomy clipping + block stage revascularization with a higher rate of good prognosis,in which endovascular embolization + convulsion stage revascularization had the highest benefit.(5)Intravascular embolization +Ⅱ stage reconstruction is the first choice for MMD patients with peripheral aneurysm.When the operation is difficult to implement,simple or conservative treatment can also achieve certain results.Conclusion:(1)MMD patients with intracranial aneurysms have a higher risk of bleeding,and aggressive surgical treatment is recommended.(2)MMD associated aneurysms are more common in main arteries and anterior circulation.(3)The appropriate treatment should be selected according to different parts and different conditions.In patients with MMD,revascularization can be used as an alternative treatment option,but regular follow-up observation is required and active treatment of aneurysms is recommended.For main aneurysms,endovascular embolization is the first choice,followed by craniotomy and clipping.At the same time,stage Ⅰ or stage IV revascularization can be combined.For peripheral aneurysms,endovascular embolization is the first choice,and the parent artery can be occluded if necessary,followed by revascularization,and craniotomy clipping is not recommended.(4)When the operation is difficult,conservative treatment or simple revascularization can also achieve certain results. |
