Seol Ho Jun, Wang Kyu-Chang, Kim Seung-Ki, Hwang Yong-Seung, Kim Ki Joong, Cho Byung-Kyu
Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, Korea.
J Neurosurg. 2005 Nov;103(5 Suppl):439-42. doi: 10.3171/ped.2005.103.5.0439.
Patients with moyamoya disease complain of headache before surgery, after surgery, or in both periods. To clarify the pathophysiological features of these headaches which are one of the major symptoms in moyamoya disease after indirect bypass surgery, the authors reviewed data obtained in patients with moyamoya disease who underwent such surgery at their institute.
The authors surveyed 204 children with moyamoya disease younger than 17 years of age who underwent indirect bypass surgery consecutively between 1988 and 2000. If headache and associated symptoms disturbed their daily activity, required rest and/or medication, and occurred at least once a month, the headache was regarded as significant and the patient was included in the study. A postoperative headache was defined as the presence of significant headache 12 months after the operation or later. Preoperative headache was documented in 44 patients. Postoperative headache was observed in 63% (28 of 44) of the patients with preoperative headache and in 6.3% (10 of 160) of those without preoperative headache. Aggravation on postoperative magnetic resonance images or single-photon emission computerized tomography scans did not correlate with this symptom (p = 0.729 and 0.203, respectively). The clinical course had the following features: 1) a coexisting stage of headache and transient ischemic attack; 2) a second stage of headache only; and 3) a final stage of improvement or disappearance of headache.
The authors demonstrated that headaches can persist or develop after indirect bypass surgery despite successful prevention of cerebral ischemia. In addition to decreased cerebral blood flow, progressive recruitment and redistribution of blood flow should be considered as a cause of headaches in patients with moyamoya disease.
烟雾病患者在手术前、手术后或两个时期均会出现头痛症状。为阐明这些头痛的病理生理特征,头痛是烟雾病间接搭桥手术后的主要症状之一,作者回顾了在其研究所接受此类手术的烟雾病患者所获得的数据。
作者调查了1988年至2000年间连续接受间接搭桥手术的204名17岁以下的烟雾病儿童。如果头痛及相关症状干扰了他们的日常活动,需要休息和/或药物治疗,且每月至少发生一次,则该头痛被视为严重头痛,患者被纳入研究。术后头痛定义为术后12个月或更晚出现严重头痛。44例患者有术前头痛记录。术前有头痛的患者中63%(44例中的28例)出现术后头痛,术前无头痛的患者中6.3%(160例中的10例)出现术后头痛。术后磁共振成像或单光子发射计算机断层扫描的加重与该症状无关(p值分别为0.729和0.203)。临床病程具有以下特征:1)头痛与短暂性脑缺血发作并存阶段;2)仅头痛的第二阶段;3)头痛改善或消失的最后阶段。
作者证明,尽管成功预防了脑缺血,但间接搭桥手术后头痛仍可能持续或出现。除脑血流量减少外,血流的渐进性募集和重新分布应被视为烟雾病患者头痛的一个原因。