Chen Chuan, Wang Hui, Hou Bo, Luo Lun, Guo Ying
Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
World Neurosurg. 2018 Feb;110:e203-e211. doi: 10.1016/j.wneu.2017.10.137. Epub 2017 Nov 1.
To summarize therapeutic efficacy of modified pial synangiosis in children with moyamoya disease and our experience with this method.
A retrospective study was conducted to analyze clinical efficacy of modified pial synangiosis in children with moyamoya disease who were treated between October 2002 and August 2015 at our center. Clinical characteristics of these rare cases were summarized, and surgical efficacy was assessed based on long-term follow-up results.
We employed modified pial synangiosis to treat 10 children with moyamoya disease; 18 modified pial synangiosis procedures were performed. The study included 2 boys and 8 girls (mean age at disease onset, 6.5 years ± 2.6). According to preoperative digital subtraction angiography, Suzuki grade III was noted in 80% (16/20) of hemispheres, and Suzuki grade II was noted in the remaining hemispheres (4/20). Mean follow-up period was 63.4 months ± 36.0. During the follow-up period, 2 cases of transient ischemic attack were reported. The remaining patients had no evidence of cerebral ischemia, seizures, or cerebral hemorrhage. Postoperative assessments based on Matsushima classification scores showed that patients with grade A revascularization accounted for 66.7% (12/18) of treated hemispheres, patients with grade B accounted for 27.8% (5/18), and patients with grade C accounted for 5.6% (1/18).
Our clinical findings provide data on efficacy and safety of modified pial synangiosis, but analysis of more cases is necessary to draw solid conclusions. A randomized controlled study is required to verify improved surgical efficacy of modified pial synangiosis.
总结改良软脑膜血管吻合术治疗儿童烟雾病的疗效及我们运用该方法的经验。
进行一项回顾性研究，分析2002年10月至2015年8月在本中心接受治疗的烟雾病患儿采用改良软脑膜血管吻合术的临床疗效。总结这些罕见病例的临床特征，并根据长期随访结果评估手术疗效。
我们采用改良软脑膜血管吻合术治疗10例烟雾病患儿；共进行了18次改良软脑膜血管吻合手术。研究包括2名男孩和8名女孩（疾病发病时的平均年龄为6.5岁±2.6岁）。根据术前数字减影血管造影，80%（16/20）的半球为铃木三级，其余半球（4/20）为铃木二级。平均随访期为63.4个月±36.0个月。随访期间，报告了2例短暂性脑缺血发作。其余患者无脑缺血、癫痫或脑出血的证据。基于松岛分类评分的术后评估显示，血管重建为A级的患者占治疗半球的66.7%（12/18），B级患者占27.8%（5/18），C级患者占5.6%（1/18）。
我们的临床研究结果提供了改良软脑膜血管吻合术疗效和安全性的数据，但需要分析更多病例才能得出确凿结论。需要进行一项随机对照研究来验证改良软脑膜血管吻合术手术疗效的提高。
