评估儿童和成年烟雾病患者后循环受累的差异。

Assessment of the difference in posterior circulation involvement between pediatric and adult patients with moyamoya disease.

机构信息

Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.

出版信息

J Neurosurg. 2013 Oct;119(4):961-5. doi: 10.3171/2013.6.JNS122099. Epub 2013 Aug 2.

DOI:10.3171/2013.6.JNS122099

PMID:23909250

Abstract

OBJECT

There is no description of the change in the posterior cerebral artery (PCA) in the diagnostic criteria of moyamoya disease (MMD). However, PCAs are often involved in the clinical setting, and an understanding of the significance of PCA lesions is therefore of great importance when evaluating the disease progression and predicting prognosis. The aim of this study was to assess the difference in posterior circulation involvement in pediatric and adult patients with MMD.

METHODS

The records of 120 consecutive patients with MMD were reviewed. The clinical manifestations at diagnosis were evaluated on the basis of symptoms and CT and MRI findings. The degree of steno-occlusive internal carotid artery (ICA) lesions and the existence of steno-occlusive PCA lesions were evaluated by observing a total of 240 ICAs and PCAs on angiography. Angiographic correlation between anterior and posterior circulation was assessed in pediatric and adult patients with MMD.

RESULTS

Seventeen (26%) of 66 pediatric patients and 18 (33%) of 54 adult patients exhibited steno-occlusive PCA lesions. There was no significant difference in the prevalence of PCA lesions between pediatric and adult patients with MMD (p = 0.36). The prevalence of infarction in pediatric and adult patients with PCA involvement was significantly higher than that in pediatric and adult patients without PCA involvement (p = 0.0003 and p = 0.003, respectively). There was no significant difference in the distribution of infarction areas between pediatric and adult patients with PCA involvement (p = 0.62). On the basis of the staging system used, steno-occlusive lesions in ICAs ipsilateral to PCAs with lesions were in significantly advanced stages compared with lesions in ICAs ipsilateral to PCAs without lesions in both pediatric and adult cases (p < 0.0001 and p = 0.0008, respectively). Pediatric patients had less advanced steno-occlusive lesions in ICAs ipsilateral to PCAs with lesions compared with adults (p < 0.05).

CONCLUSIONS

The clinical significance of posterior circulation involvement in MMD was similar between pediatric and adult patients. The only significant difference was that less advanced ICA lesions could complicate posterior circulation involvement in pediatric patients.

摘要

目的

在烟雾病（MMD）的诊断标准中，没有描述大脑后动脉（PCA）的变化。然而，在临床实践中，PCA 常常会受到影响，因此，了解 PCA 病变的意义对于评估疾病进展和预测预后非常重要。本研究旨在评估儿童和成年 MMD 患者后循环受累的差异。

方法

回顾了 120 例连续 MMD 患者的记录。根据症状和 CT 和 MRI 发现评估诊断时的临床表现。通过观察总共 240 条颈内动脉（ICA）和 PCA，评估 ICA 狭窄闭塞病变的程度和 PCA 狭窄闭塞病变的存在。评估了儿童和成年 MMD 患者前后循环的血管造影相关性。

结果

66 例儿科患者中有 17 例（26%）和 54 例成年患者中有 18 例（33%）存在 PCA 狭窄闭塞病变。MMD 患儿和成年患者 PCA 病变的发生率无显著差异（p = 0.36）。PCA 受累的儿童和成年患者的梗塞发生率明显高于 PCA 无受累的儿童和成年患者（p = 0.0003 和 p = 0.003）。PCA 受累的儿童和成年患者梗塞区域的分布无显著差异（p = 0.62）。根据使用的分期系统，与 PCA 无病变的同侧 ICA 病变相比，PCA 病变同侧 ICA 的狭窄闭塞病变处于明显更晚期（p < 0.0001 和 p = 0.0008，分别）。与成人相比，儿童患者 PCA 病变同侧 ICA 的狭窄闭塞病变程度较轻（p < 0.05）。