Department of Neurosurgery, Sheba Medical Center Hospital-Tel Hashomer, Ramat Gan, Israel; Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA.
Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA.
World Neurosurg. 2021 May;149:e16-e21. doi: 10.1016/j.wneu.2021.02.102. Epub 2021 Feb 27.
Moyamoya disease refers to a progressive vasostenotic or vaso-occlusive disease that puts patients at risk for ischemic and/or hemorrhagic events. Surgical revascularization procedures aim to restore cerebral blood flow to mitigate stroke risk and functional decline. Direct and indirect bypass procedures have been proposed. Encephaloduroarteriosynangiosis (EDAS) with dural inversion is a well-accepted indirect procedure.
Patients with moyamoya disease undergoing EDAS with dural inversion between 2000 and 2019 were retrospectively reviewed. Clinical data including short-term and long-term outcome were measured using the modified Rankin Scale. Patient satisfaction was assessed in patients with a minimum of 3 years of clinical follow-up.
Over a 20-year period, 54 patients underwent 88 EDAS with dural inversion procedures. Most patients underwent bilateral surgery (34/54 patients, 63.0%). Median age at surgery was 19 years (range, 1-63 years) with a median follow-up of 6 years (range, 1-20 years). Periprocedural complications occurred in 4 of 54 patients (7.4%). Periprocedural infarction occurred in 3 of 88 operations (3.4%). Functional outcome at 90 days was favorable (modified Rankin Scale score 0-2) in 92.6% of cases. On long-term follow-up, 3 patients experienced ischemic infarction (5.6%), and 1 patient (1.9%) experienced hemorrhagic infarction. Patients' overall satisfaction with the surgical procedure at last follow-up was determined in 36 of 45 patients with at least 3 years of follow-up (response rate 80.0%). Median satisfaction was very good (score 5; range, 3-5).
EDAS with dural inversion is a safe and effective indirect revascularization procedure for pediatric and adult moyamoya disease that is associated with favorable long-term outcomes and high patient satisfaction.
烟雾病是一种进行性的血管狭窄或闭塞性疾病，使患者面临缺血和/或出血事件的风险。手术血运重建旨在恢复脑血流以降低中风风险和功能下降。已经提出了直接和间接旁路手术。带脑膜翻转的颅内外血管融通术（EDAS）是一种公认的间接手术。
回顾性分析了 2000 年至 2019 年间接受带脑膜翻转的 EDAS 的烟雾病患者。使用改良 Rankin 量表测量短期和长期结果等临床数据。对至少有 3 年临床随访的患者进行患者满意度评估。
在 20 年期间，54 例患者接受了 88 例带脑膜翻转的 EDAS 手术。大多数患者接受了双侧手术（34/54 例，63.0%）。手术时的中位年龄为 19 岁（范围为 1-63 岁），中位随访时间为 6 年（范围为 1-20 年）。54 例患者中有 4 例（7.4%）发生围手术期并发症。88 例手术中有 3 例（3.4%）发生围手术期梗死。90 天的功能预后良好（改良 Rankin 量表评分为 0-2）的比例为 92.6%。在长期随访中，3 例患者发生缺血性梗死（5.6%），1 例患者（1.9%）发生出血性梗死。在至少 3 年随访的 36 例患者中确定了患者对手术的总体满意度（应答率 80.0%）。中位满意度为非常好（评分为 5；范围为 3-5）。
带脑膜翻转的 EDAS 是一种安全有效的小儿和成人烟雾病间接血运重建术，具有良好的长期结果和高患者满意度。
