Li Xin, Huang Zheng, Wu Ming-Xing, Zhang Dong
1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
2Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China.
Aging Dis. 2017 Jul 21;8(4):384-391. doi: 10.14336/AD.2016.1115. eCollection 2017 Jul.
Superficial temporal artery-middle cerebral artery (STA-MCA) has been used for the treatment of occlusive cerebrovascular disease including moyamoya disease. The effect of STA-MCA bypass depends not only on the patency of anastomosis, but also on integrity and functional capacity of the donor artery. In the present prospective study, we investigated the effect of extensive stripping STA adventitia and fasciae on hemodynamic function in STA-MCA bypass of moyamoya disease patients. Twenty patients (n=8 in control group, n=12 in stripping group) of moyamoya disease were subjected to STA-MCA end-to-side direct anastomosis. Perfusion unit (PU) values of the cortex were measured and recorded using a Laser Doppler flowmetry (LDF) for 5 days. Computed tomography perfusion was performed to determine blood flow before and after bypass. No patient experienced significant neurologic deficits associated with neurosurgical complications. LDF demonstrated that adventitial stripping group had higher cerebral blood flow increase than control group. The adventitia stripping group tends to have higher rate of increased cerebral perfusion after bypass than non-stripping group. Furthermore, the ultrasound examination at 3 days after bypass demonstrated that the adventitial stripping group has a tendency of bigger STA and higher peak systolic velocity than control group. Our result suggests that stripping adventitia of STA improves hemodynamics of STA-MCA bypass in moyamoya disease.
颞浅动脉-大脑中动脉（STA-MCA）已被用于治疗包括烟雾病在内的闭塞性脑血管疾病。STA-MCA搭桥术的效果不仅取决于吻合口的通畅性，还取决于供体动脉的完整性和功能能力。在本前瞻性研究中，我们调查了广泛剥离STA外膜和筋膜对烟雾病患者STA-MCA搭桥术中血流动力学功能的影响。20例烟雾病患者（对照组8例，剥离组12例）接受了STA-MCA端侧直接吻合术。使用激光多普勒血流仪（LDF）测量并记录皮质的灌注单位（PU）值，持续5天。进行计算机断层扫描灌注以确定搭桥前后的血流量。没有患者出现与神经外科并发症相关的明显神经功能缺损。LDF显示，外膜剥离组的脑血流量增加高于对照组。外膜剥离组搭桥后脑灌注增加率往往高于未剥离组。此外，搭桥后3天的超声检查显示，外膜剥离组STA有变大的趋势，收缩期峰值速度高于对照组。我们的结果表明，剥离STA外膜可改善烟雾病患者STA-MCA搭桥术的血流动力学。
