Blauwblomme Thomas, Mathon Bertrand, Naggara Olivier, Kossorotoff Manoelle, Bourgeois Marie, Puget Stéphanie, Meyer Philippe, Brousse Valentine, de Montalembert Marianne, Brunelle Francis, Zerah Michel, Sainte-Rose Christian
Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.
APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France.
Neurosurgery. 2017 Jun 1;80(6):950-956. doi: 10.1093/neuros/nyw161.
Multiple burr hole (MBH) surgery is a simple, safe, and effective indirect technique of revascularization in moyamoya angiopathy (MM). However, it is not yet recognized as a first-line treatment.
To assess the long-term outcome and perioperative complications in a large single-center cohort of children with MM who underwent burr hole surgery.
This study is a retrospective analysis of children who underwent surgery for MM in a national reference center for pediatric stroke between 1999 and 2015. Sixty-four children (108 hemispheres, median age 7 years) were consecutively treated. The indication for revascularization was previous stroke or transient ischemic attack (TIA) or rapidly progressive disease on brain magnetic resonance imaging (MRI) and digital subtraction angiography. Children were followed with clinical examinations, telephone interviews, and MRI with any clinical recurrence of stroke or TIA used as the primary endpoint. Surgical mortality and morbidity were documented.
Sixty-four patients were operated (bilateral MBH n = 39, unilateral procedure n = 25). At a mean follow-up of 4.2 years and 270.6 patient years, 89.1% of patients had not suffered any recurrent stroke or TIA. A second surgery was required in 5 cases after unilateral revascularization, and in 3 cases after bilateral MBH. Mortality associated with the procedure was 0. Postoperative Matsushima angiographic grading was the only predictive factor of ischemic recurrence ( P = .036).
In pediatric MM, MBH compares favorably to other indirect or direct revascularization techniques in children in the prevention of stroke or TIA.
多骨瓣钻孔（MBH）手术是烟雾病（MM）一种简单、安全且有效的间接血运重建技术。然而，它尚未被视为一线治疗方法。
评估在一个大型单中心队列中接受骨瓣钻孔手术的MM患儿的长期结局和围手术期并发症。
本研究是对1999年至2015年期间在一家全国性小儿卒中参考中心接受MM手术的患儿进行的回顾性分析。连续治疗了64名儿童（108个半球，中位年龄7岁）。血运重建的指征为既往卒中或短暂性脑缺血发作（TIA），或脑磁共振成像（MRI）和数字减影血管造影显示的快速进展性疾病。对患儿进行临床检查、电话访谈，并以任何临床复发性卒中或TIA作为主要终点进行MRI检查。记录手术死亡率和发病率。
64例患者接受了手术（双侧MBH手术39例，单侧手术25例）。平均随访4.2年，共270.6患者年，89.1%的患者未发生任何复发性卒中或TIA。单侧血运重建后5例患者需要进行二次手术，双侧MBH手术后3例患者需要进行二次手术。与手术相关的死亡率为0。术后松岛血管造影分级是缺血复发的唯一预测因素（P = 0.036）。
在小儿MM中，与其他间接或直接血运重建技术相比，MBH在预防卒中或TIA方面具有优势。
