Department of Neurosurgery, Uijongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine, Uijongbu, 480-130, Korea.
Acta Neurochir (Wien). 2012 Jul;154(7):1179-87. doi: 10.1007/s00701-012-1325-1. Epub 2012 Apr 3.
To clarify the most beneficial treatment of the management modality based on our experience with adult moyamoya disease (MMD).
From 1998 to 2010, clinical results of 142 patients (ischemic, 98; hemorrhagic, 44) with adult MMD were investigated according to management modality. Revascularization surgery (direct, indirect, and combined bypass) was performed in 124 patients. We observed the clinical course of 18 patients who were treated conservatively. Clinical outcome, angiographic features, hemodynamic change, and incidence of recurrent stroke were investigated pre- and postoperatively.
In patients with ischemic MMD, direct and combined bypasses were more effective treatments to prevent recurrent ischemic stroke than indirect bypass surgery (P < 0.05). In patients with hemorrhagic MMD, rebleeding was less likely to occur in patients who had undergone bypass surgery. However, no significant difference was observed in the rebleeding rate between patients with and without revascularization surgery (P > 0.05). An angiogram after bypass surgery comparing the extent of revascularization and reduction of moyamoya vessels in patients treated with direct, indirect, and combined bypass showed a significant difference (P < 0.05) in favor of direct and combined bypass. Postoperative angiographic changes and SPECT results demonstrated significant statistical correlation (P < 0.05).
Revascularization surgery was effective in further ischemic stroke prevention to a statistically significant extent. Direct and combined bypasses were more effective to prevent recurrent ischemic stroke than indirect bypass. However, there is still no clear evidence that revascularization surgery significantly prevents rebleeding in adult MMD patients. More significant angiographic changes were observed in direct and combined bypasses compared with indirect bypass.
为了根据我们在成人烟雾病（MMD）方面的经验阐明最有益的治疗管理方式。
1998 年至 2010 年，根据治疗方式对 142 例成人 MMD 患者（缺血性 98 例，出血性 44 例）的临床结果进行了调查。对 124 例患者进行了血运重建手术（直接、间接和联合旁路）。我们观察了 18 例保守治疗患者的临床过程。在手术前后对临床结果、血管造影特征、血流动力学变化和复发性中风的发生率进行了调查。
在缺血性 MMD 患者中，直接和联合旁路比间接旁路手术更有效地预防复发性缺血性中风（P<0.05）。在出血性 MMD 患者中，旁路手术后再出血的可能性较小。然而，在接受和未接受血运重建手术的患者之间，再出血率无显著差异（P>0.05）。直接、间接和联合旁路治疗患者的旁路手术后血管造影比较显示，在再通程度和烟雾血管减少方面有显著差异（P<0.05），直接和联合旁路更有优势。术后血管造影变化和 SPECT 结果表明，两者之间存在显著的统计学相关性（P<0.05）。
血运重建手术在进一步预防缺血性中风方面具有统计学意义的效果。直接和联合旁路比间接旁路更有效地预防复发性缺血性中风。然而，在成人 MMD 患者中，血运重建手术是否能显著预防再出血仍无明确证据。与间接旁路相比，直接和联合旁路观察到更显著的血管造影变化。
