Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
World Neurosurg. 2014 Jan;81(1):91-8. doi: 10.1016/j.wneu.2013.05.010. Epub 2013 Jun 5.
Moyamoya disease (MMD) has inspired the development and refinement of numerous surgical techniques to induce revascularization in hypoperfused territories. Over the last 3 decades, the use of burr hole surgery has progressively gained popularity. Used either in combination with another direct or indirect procedure or as the sole method for revascularization, burr hole surgery can be tailored to each patient's specific needs. We reviewed the conceptual progress, the technical evolution, and the clinical and radiological data following burr hole surgery.
Pubmed and Medline databases were searched for publications from 1970 to 2012 relating to the use of burr holes in the surgical management of MMD. The reference sections of each article were reviewed, and pertinent articles were identified.
A review of case reports and case series using burr hole surgery for MMD testifies to the progressive refinement in the decision process and key technical aspects of this procedure. Favorable clinical and angiographic results have been documented in the pediatric and adult MMD population after burr holes, used either in combination with direct or indirect revascularization techniques, or more recently alone in the setting of multiple burr holes. The superficial temporal artery and middle meningeal artery have both been found to contribute to revascularization via burr holes.
Burr hole surgery is an important and versatile tool in the armamentarium of surgeons treating children and adults with MMD, allowing tailoring of the revascularization. Further studies should help to determine factors that may help predict optimal revascularization from this surgical technique.
烟雾病（MMD）激发了许多诱导血运重建的手术技术的发展和完善，以改善灌注不足区域的血流。在过去的 30 年中，颅骨打孔术的应用逐渐普及。颅骨打孔术可单独使用，也可与其他直接或间接手术联合使用，作为一种血管重建方法，可根据每位患者的具体需求进行调整。我们回顾了颅骨打孔术的概念进展、技术演变以及临床和影像学数据。
在 1970 年至 2012 年期间，我们在 PubMed 和 Medline 数据库中搜索了有关颅骨打孔术治疗 MMD 的使用的出版物。我们查阅了每篇文章的参考文献部分，并确定了相关文章。
使用颅骨打孔术治疗 MMD 的病例报告和病例系列回顾证明了该手术决策过程和关键技术方面的不断完善。在儿童和成人 MMD 患者中，颅骨打孔术与直接或间接血管重建技术联合使用，或最近单独使用多个颅骨打孔术，都取得了良好的临床和血管造影结果。研究发现，颅骨打孔术可通过颞浅动脉和脑膜中动脉来实现血运重建。
颅骨打孔术是治疗儿童和成人 MMD 患者的重要且多功能的手术工具，可实现血管重建的个体化。进一步的研究应该有助于确定可能有助于预测这种手术技术最佳血管重建的因素。
