Williamson Richard W, Abla Adib A, Zabramski Joseph M, Nakaji Peter, Spetzler Robert F, Wanebo John E
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
World Neurosurg. 2017 Mar;99:37-40. doi: 10.1016/j.wneu.2016.11.073. Epub 2016 Nov 24.
Moyamoya angiopathy most often manifests in patients in the second and third decades of life. Although uncommon, it can also manifest later in life. We present our results in patients >50 years old with moyamoya angiopathy who were treated with surgical revascularization via either direct bypass or indirect bypass (encephaloduroarteriosynangiosis).
A retrospective review was conducted to identify patients with moyamoya disease who were treated with surgical revascularization at our institution between 2002 and 2015. Outcomes and complications were analyzed.
We identified 33 patients with moyamoya angiopathy >50 years old (mean age 59.0 years ± 7.6) who were treated with surgical revascularization of 45 affected hemispheres. Of the affected hemispheres, 27 (60%) were treated with indirect bypasses and 18 (40%) were treated with direct bypasses. Neurologic complications occurred in 4 (12%) patients. The mean length of follow-up was 18.7 months ± 18.6; 4 patients were lost to follow-up. At last follow-up, 11 of 18 (61%) direct bypasses were patent. Treatment failed in 5 of 45 (11%) treated hemispheres (stroke in 2 and persistent transient ischemic attacks in 3). In terms of functional outcome at last follow-up, 16 of 29 (55%) patients were the same as before surgery, 10 (35%) were better, and 3 (10%) were worse (including 1 death).
Although uncommon, moyamoya angiopathy can manifest in older adults. Surgical revascularization is a reasonable treatment option with good functional outcomes and an acceptable complication rate.
烟雾病性血管病最常发生于二三十岁的患者。虽然不常见，但也可在晚年发病。我们报告了年龄>50岁的烟雾病性血管病患者接受直接搭桥或间接搭桥（脑硬脑膜动脉血管融合术）手术血运重建治疗的结果。
进行回顾性研究，以确定2002年至2015年期间在我院接受手术血运重建治疗的烟雾病患者。分析其结局和并发症。
我们确定了33例年龄>50岁（平均年龄59.0岁±7.6）的烟雾病性血管病患者，他们接受了45个患侧半球的手术血运重建。在这些患侧半球中，27个（60%）接受了间接搭桥，18个（40%）接受了直接搭桥。4例（12%）患者发生了神经系统并发症。平均随访时间为18.7个月±18.6；4例患者失访。在最后一次随访时，18个直接搭桥中有11个（61%）通畅。45个接受治疗的半球中有5个（11%）治疗失败（2例发生卒中，3例持续有短暂性脑缺血发作）。在最后一次随访时的功能结局方面，29例患者中有16例（55%）与术前相同，10例（35%）有所改善，3例（10%）恶化（包括1例死亡）。
虽然不常见，但烟雾病性血管病可在老年人中发病。手术血运重建是一种合理的治疗选择，功能结局良好，并发症发生率可接受。
