带蒂颞浅筋膜瓣在烟雾病联合血运重建中的初步经验教训：病例系列。

Lessons Learned from the Initial Experience with Pedicled Temporoparietal Fascial Flap for Combined Revascularization In Moyamoya Angiopathy: A Case Series.

机构信息

Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

出版信息

World Neurosurg. 2019 Dec;132:e259-e273. doi: 10.1016/j.wneu.2019.08.182. Epub 2019 Sep 3.

DOI:10.1016/j.wneu.2019.08.182

PMID:31491577

Abstract

BACKGROUND

The pedicled temporoparietal fascial flap (TPFF) with a direct superficial temporal (STA) artery to middle cerebral artery (MCA) bypass is a novel combined revascularization approach for moyamoya angiopathy (MMA). With this case series, we aim to report the initial experience with pedicled TPFF combined revascularization for MMA treatment.

METHODS

Data from 14 consecutive patients undergoing pedicled TPFF combined revascularization for MMA between May 2016 and December 2018 were retrospectively reviewed. Patients admitted with acute ischemia or a modified Rankin Scale (mRS) score >3 were considered high risk.

RESULTS

Mean ± standard deviation age on surgery was 41.9 ± 15.4 years. Three of 14 patients (21.4%) presented with an mRS score >3. Nine of 14 patients (64.3%) presented with ischemic stroke, 4 of whom (44.4%) had acute ischemia. Direct anastomosis patency was confirmed in all cases postoperatively. Mean hospitalization time was 13 ± 9.3 days and mean follow-up time was 14.1 ± 9.3 months. From admission to follow-up, neurologic status improved in 8 patients (57.1%) and stabilized in 6 patients (42.9%). Overall, 11/14 patients (78.6%) achieved good functional outcome (mRS score ≤2). All patients achieved some radiographic collateral development, with 5 (71.5%) graded as Matsushima A and B. Three patients developed new radiographic ischemia and 3 experienced wound complications, all in the high-risk group.

CONCLUSIONS

The TPFF combined approach is a viable strategy for revascularization in MMA. This technique may be suboptimal in patients presenting with acute ischemia and/or mRS score >3.

摘要

背景

带直接颞浅动脉（STA）至大脑中动脉（MCA）旁路的带蒂颞顶筋膜皮瓣（TPFF）是一种新颖的联合血运重建方法，用于治疗烟雾病（MMA）。通过本病例系列，我们旨在报告带蒂 TPFF 联合血运重建治疗 MMA 的初步经验。

方法

回顾性分析 2016 年 5 月至 2018 年 12 月期间 14 例接受带蒂 TPFF 联合血运重建治疗 MMA 的连续患者的数据。患有急性缺血或改良 Rankin 量表（mRS）评分>3 的患者被认为是高危患者。

结果

手术时的平均年龄为 41.9±15.4 岁。14 例患者中有 3 例（21.4%）mRS 评分>3。14 例患者中有 9 例（64.3%）出现缺血性脑卒中，其中 4 例（44.4%）为急性缺血。所有病例术后均证实直接吻合通畅。平均住院时间为 13±9.3 天，平均随访时间为 14.1±9.3 个月。从入院到随访，8 例患者（57.1%）神经状态改善，6 例患者（42.9%）稳定。总体而言，14 例患者中有 11 例（78.6%）获得良好的功能结局（mRS 评分≤2）。所有患者均有一些放射性侧支发育，其中 5 例（71.5%）为 Matsushima A 和 B 级。3 例患者出现新的放射性缺血，3 例患者出现伤口并发症，均发生在高危组。