From the Department of Neurosurgery, Seoul National University Hospital (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.), Seoul National University College of Medicine, Republic of Korea.
Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Republic of Korea (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.).
Stroke. 2019 Nov;50(11):3177-3183. doi: 10.1161/STROKEAHA.119.025609. Epub 2019 Sep 25.
Background and Purpose- In pediatric moyamoya disease, there are few reports on the efficacy of surgical intervention for stroke prevention. We evaluated the long-term outcomes of indirect bypass surgery on a relatively large number of children with moyamoya disease in a single center. Methods- From August 1988 to December 2012, 772 children underwent indirect bypass surgery. This study included 629 patients who were followed up for >5 years, excluding patients with moyamoya syndrome. The mean clinical follow-up duration was 12 years (range, 5-29 years). Cross-sectional analysis was performed based on either Karnofsky Performance Scale or Lansky Play Performance Scale to evaluate overall clinical outcomes and factors associated with unfavorable outcomes. To analyze the longitudinal effect of surgery, the annual risk of symptomatic infarction or hemorrhage on the operated hemisphere after indirect bypass surgery was calculated with a person-year method, and the event-free survival rate was evaluated using the Kaplan-Meier method. Results- The overall clinical outcome was favorable in 95% of the patients. The annual risks of symptomatic infarction and hemorrhage on the operated hemispheres were 0.08% and 0.04%, respectively. Furthermore, the 10-year event-free survival rates for symptomatic infarction and hemorrhage were 99.2% and 99.8%. Conclusions- Indirect bypass surgery could provide satisfactory long-term improvement in overall clinical outcome and prevention of recurrent stroke in children with moyamoya disease.
背景与目的-在儿科烟雾病中，关于手术干预预防中风的疗效报告较少。我们评估了在单中心对相对大量烟雾病患儿进行间接旁路手术的长期结果。
方法-1988 年 8 月至 2012 年 12 月，772 名儿童接受了间接旁路手术。本研究包括 629 名随访时间超过 5 年的患者，排除了烟雾综合征患者。平均临床随访时间为 12 年（范围，5-29 年）。根据 Karnofsky 表现量表或 Lansky 游戏表现量表进行横断面分析，评估整体临床结果和与不良结果相关的因素。为了分析手术的纵向效果，采用人年法计算间接旁路手术后对侧半球发生症状性梗死或出血的年风险，并采用 Kaplan-Meier 法评估无事件生存率。
结果-95%的患者总体临床结果良好。对侧半球发生症状性梗死和出血的年风险分别为 0.08%和 0.04%。此外，症状性梗死和出血的 10 年无事件生存率分别为 99.2%和 99.8%。
结论-间接旁路手术可在烟雾病患儿中提供令人满意的长期整体临床改善和预防复发性中风。
