Department of Neurosurgery, Miyagi Children's Hospital, Sendai, Japan (T.H., T.K., R.S.).
Department of Neurosurgery, Sendai City Hospital, Japan (H.K.).
Stroke. 2021 Jul;52(7):2302-2310. doi: 10.1161/STROKEAHA.120.032699. Epub 2021 May 11.
In pediatric moyamoya disease, there have been few reports of the risk factors for preoperative cerebral infarction, especially during the waiting period before surgery. The clinical and radiological findings of surgically treated pediatric moyamoya patients were evaluated to analyze the risk factors for cerebral infarction seen from onset to surgery.
Between August 2003 and September 2019, 120 hemispheres of 71 patients under 18 years of age with moyamoya disease were surgically treated by direct and indirect bypass procedures. The mean age of all surgical hemispheres at diagnosis was 6.7±3.9 years (6 months–17 years). The potential risk factors for preoperative infarction were examined statistically.
Multivariate logistic regression analysis showed that risk factors for infarction at the time of diagnosis were age at diagnosis (odds ratio [OR], 0.68 [95% CI, 0.57–0.82]; P<0.0001) and the magnetic resonance angiography (MRA) score (OR, 2.29 [95% CI, 1.40–3.75]; P=0.001). Univariate analysis showed that risk factors for infarction while waiting for surgery were age at diagnosis (OR, 0.61 [95% CI, 0.46–0.80]; P<0.0001), the MRA score (OR, 1.75 [95% CI, 1.26–2.41]; P=0.0003), and onset of infarction (OR, 40.4 [95% CI, 5.08–322.3]; P<0.0001). Multiple comparisons showed that patients under 4 years of age were at a significantly high risk of infarction at the time of diagnosis and while waiting for surgery. Time from diagnosis to surgery of >2 months was a significant risk factor for infarction while waiting for surgery in patients under 6 years of age.
Young age at diagnosis and a high MRA score may be associated with rapid disease progression and result in preoperative infarction. We recommend that surgery be performed within 2 months of diagnosis for the patients under 4 years of age with a high MRA score (>5) and cerebral infarction. Further study is needed to define the optimal timing of surgery.
在儿科烟雾病中，术前脑梗死的危险因素，特别是在手术前等待期间的危险因素报道较少。本研究评估了经手术治疗的儿科烟雾病患者的临床和影像学发现，以分析从发病到手术期间脑梗死的危险因素。
2003 年 8 月至 2019 年 9 月，对 71 例年龄在 18 岁以下的烟雾病患者的 120 个半脑进行了直接和间接旁路手术治疗。所有手术半脑的平均诊断年龄为 6.7±3.9 岁（6 个月至 17 岁）。统计学分析了术前梗死的潜在危险因素。
多变量逻辑回归分析显示，诊断时梗死的危险因素是诊断时的年龄（比值比 [OR]，0.68 [95%置信区间，0.57-0.82]；P<0.0001）和磁共振血管造影（MRA）评分（OR，2.29 [95%置信区间，1.40-3.75]；P=0.001）。单因素分析显示，手术前等待期间梗死的危险因素为诊断时的年龄（OR，0.61 [95%置信区间，0.46-0.80]；P<0.0001）、MRA 评分（OR，1.75 [95%置信区间，1.26-2.41]；P=0.0003）和梗死发病（OR，40.4 [95%置信区间，5.08-322.3]；P<0.0001）。多重比较显示，4 岁以下的患者在诊断时和手术前等待期间的梗死风险明显较高。对于 6 岁以下的患者，从诊断到手术的时间超过 2 个月是手术前等待期间梗死的一个显著危险因素。
诊断时的年龄较小和较高的 MRA 评分可能与疾病的快速进展有关，并导致术前梗死。我们建议对于 MRA 评分较高（>5）且伴有脑梗死的 4 岁以下患儿，应在诊断后 2 个月内进行手术。需要进一步研究以确定手术的最佳时机。
