Sahoo Siddhartha Shankar, Suri Ashish, Bansal Sumit, Devarajan S Leve Joseph, Sharma Bhawani Shankar
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
Asian J Neurosurg. 2015 Oct-Dec;10(4):252-9. doi: 10.4103/1793-5482.162681.
Moyamoya disease (MMD) is a chronic progressive cerebrovascular occlusive disease affecting commonly the anterior circle of Willis. Matushima grade inadequately reflects the angiographic changes postrevascularization procedure.
To analyze the clinical and angiographic outcome of revascularization procedures (direct [ST-middle cerebral artery (MCA) anastomosis] and indirect [encephalo-duro-arterio-myo-synangiosis (EDAMS)]) in MMD and validate a new angiographic scoring system.
Retrospective study included symptomatic patients of MMD who underwent revascularization; both indirect and combined methods between January 2002 and April 2012. Follow-up angiography was done after at least 3 months. We devised a novel scoring system the "angiographic outcome score" (AOS) including reformation of distal MCA and anterior cerebral artery, regression of basal moyamoya vessels, leptomeningeal collaterals and overall perfusion. AOS was applied to the angiograms independently by a neuroradiologist and a neurosurgeon that were blinded toward its preoperative or postoperative status.
Totally 33 patients underwent 36 EDAMS and 4 combined procedures (EDAMS + ST-MCA bypass). The mean follow-up was 20 months. None had recurrent transient ischemic attack or fresh infarct. Postoperative AOS was significantly higher than preoperative AOS. The Spearman rho showed positive correlation between Matushima grade and postoperative AOS. Significant regression of basal moyamoya vessels and increase in number of loci of transdural collaterals was seen.
EDAMS is a simple yet effective method of revascularization in both pediatric as well as adult age groups. AOS is a simple, precise and easily reproducible scoring system, which reflects the favorable angiographic changes after revascularization.
烟雾病（MMD）是一种慢性进行性脑血管闭塞性疾病，通常影响 Willis 环前部。Matushima 分级不能充分反映血运重建术后的血管造影变化。
分析烟雾病血运重建手术（直接手术[颞浅动脉-大脑中动脉（MCA）吻合术]和间接手术[脑-硬膜-动脉-肌-血管融合术（EDAMS）]）的临床和血管造影结果，并验证一种新的血管造影评分系统。
回顾性研究纳入了 2002 年 1 月至 2012 年 4 月期间接受血运重建的烟雾病症状性患者；包括间接手术和联合手术。至少 3 个月后进行随访血管造影。我们设计了一种新的评分系统“血管造影结果评分”（AOS），包括大脑中动脉远端和大脑前动脉的重塑、基底烟雾状血管的消退、软脑膜侧支循环和整体灌注。一名神经放射科医生和一名神经外科医生对血管造影进行独立评分，他们对术前或术后状态不知情。
共有 33 例患者接受了 36 次 EDAMS 手术和 4 次联合手术（EDAMS + 颞浅动脉-大脑中动脉搭桥术）。平均随访时间为 20 个月。无一例出现复发性短暂性脑缺血发作或新发梗死。术后 AOS 显著高于术前 AOS。Spearman 相关系数显示 Matushima 分级与术后 AOS 呈正相关。基底烟雾状血管明显消退，硬膜外 collateral 的位点数量增加。
EDAMS 是一种在儿童和成人年龄组中简单而有效的血运重建方法。AOS 是一种简单、精确且易于重复的评分系统，反映了血运重建术后良好的血管造影变化。
