Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Medical informatics & Integrative Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
World Neurosurg. 2019 Sep;129:e594-e606. doi: 10.1016/j.wneu.2019.05.228. Epub 2019 May 31.
The underlying mechanisms of headache in adult moyamoya disease (MMD) are not clear. The aim of this study is to clarify the factors that are associated with headache in adult patients with MMD after superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis.
We retrospectively analyzed the cases of 68 adult patients with MMD: 30 with surgery and 38 without surgery. Each STA-MCA anastomosis was performed by the standard technique. Magnetic resonance angiography (MRA) and single photon emission computed tomography were performed perioperatively. We stratified the intensity and frequency of the patients' headaches into 4 ranks. Pre- and postoperative STA diameters were retrospectively measured on digital subtraction angiography (DSA) and/or MRA.
In the surgery group, preoperative regional cerebral blood flow (rCBF) laterality and a postoperative rCBF increase >20% showed no significant difference between the patients with and without headache with a univariate analysis. The postoperative STA diameters of the distal branch (DSA) and main trunk (DSA/MRA) in the patients with headache were significantly larger than those of the patients without headache. The rate of postoperative increase of the STA diameters of the distal branch/main trunk was also significantly higher in the patients with headache than those without headache. A multivariate analysis showed that the standard regression coefficient β for sex, a >20% increase of postoperative rCBF, and the increase rate of the STA diameter of the distal branch shown by DSA was 0.37, 0.54, and 0.56, respectively.
The results of our analyses revealed that aside from ischemia, the postoperative increase rate of the STA may be a candidate reason for headache, especially in adult patients with MMD.
成人烟雾病（MMD）头痛的潜在机制尚不清楚。本研究旨在阐明大脑中动脉（MCA）-颞浅动脉（STA）吻合术后成人 MMD 患者头痛的相关因素。
我们回顾性分析了 68 例成人 MMD 患者的病例：30 例手术，38 例未手术。每例 STA-MCA 吻合术均采用标准技术。术前行磁共振血管造影（MRA）和单光子发射计算机断层扫描（SPECT）检查。我们将患者头痛的强度和频率分为 4 个等级。回顾性测量数字减影血管造影（DSA）和/或 MRA 术前和术后 STA 直径。
在手术组中，单因素分析显示，术前区域性脑血流（rCBF）偏侧性和术后 rCBF 增加>20%与头痛患者和无头痛患者之间无显著差异。头痛患者的术后远端分支（DSA）和主干（DSA/MRA）STA 直径明显大于无头痛患者。头痛患者的远端分支/主干 STA 直径术后增加率也明显高于无头痛患者。多因素分析显示，性别、术后 rCBF 增加>20%和 DSA 显示的 STA 直径增加率的标准回归系数β分别为 0.37、0.54 和 0.56。
我们的分析结果表明，除了缺血外，术后 STA 增加率可能是头痛的一个候选原因，尤其是在成人 MMD 患者中。
