Department of Neurosurgery, 307th Hospital of People's Liberation Army, Anhui Medical University, Hefei, China; Department of Neurosurgery, Chinese PLA General Hospital (Former Department of Neurosurgery, the Fifth Medical Center of Chinese PLA General Hospital), Beijing, China.
Department of Neurosurgery, Chinese PLA General Hospital (Former Department of Neurosurgery, the Fifth Medical Center of Chinese PLA General Hospital), Beijing, China.
World Neurosurg. 2022 Apr;160:e511-e519. doi: 10.1016/j.wneu.2022.01.063. Epub 2022 Jan 22.
Moyamoya disease (MMD) often presents as ischemic stroke in pediatric patients and hemorrhage in adults. This situation raises questions as to whether the phenotype of moyamoya disease changes with age.
We performed self-precontrol and postcontrol observation monitoring until adulthood on abnormal collateral vessels (ACVs) with the potential risk of bleeding to evaluate the chance of further hemorrhage.
Fifteen pediatric patients with >10 years angiography-based follow-up were analyzed. The Matsushima grades were divided into 2 groups (good group, representing Matsushima stage A; and mild group, representing Matsushima stages B and C) to investigate the relationship between Matsushima grades and ACVs derived from vessels likely to cause intracranial hemorrhage.
Four patients (26.7%) had infarction type and 11 (73.3%) patients had transient ischemic attack type. No patient experienced late-onset cerebral hemorrhagic events. One patient experienced recurrent ischemic stroke 6 months after the second surgery and recovered completely after the third surgery. The angiography-based follow-up was conducted at least 10 years after the encephaloduroarteriosynangiosis (EDAS). The good Matsushima group showed a significant positive correlation with the reduction of the anterior choroidal artery (odds ratio, 56.00; P = 0.003), whereas the posterior communicating artery showed no significant decrease before and after the EDAS procedure (odds ratio, 2.00; P = 1.00).
The EDAS procedure can effectively attenuate the dilation and ACVs of the anterior choroidal artery, which may reduce the incidence of further hemorrhage in adulthood.
烟雾病（MMD）常以儿童患者缺血性卒中和成人患者出血为表现。这种情况引发了一个问题，即烟雾病的表型是否会随年龄而改变。
我们对有出血潜在风险的异常侧支血管（ACVs）进行了自我前后对照观察监测，直至成年，以评估进一步出血的机会。
分析了 15 例有>10 年血管造影随访的儿科患者。将 Matsushima 分级分为 2 组（良好组，代表 Matsushima 分期 A；轻度组，代表 Matsushima 分期 B 和 C），以研究 Matsushima 分级与可能导致颅内出血的血管来源的 ACVs 之间的关系。
4 例（26.7%）患者为梗死型，11 例（73.3%）患者为短暂性脑缺血发作型。无患者发生迟发性脑溢血事件。1 例患者在第二次手术后 6 个月再次发生缺血性卒中，第三次手术后完全恢复。血管造影随访在脑-硬脑膜-动脉血管融通术（EDAS）后至少 10 年进行。良好的 Matsushima 组与前脉络膜动脉（优势比，56.00；P=0.003）减少呈显著正相关，而颈内动脉-后交通动脉吻合术前后后交通动脉无明显减少（优势比，2.00；P=1.00）。
EDAS 手术可有效减轻前脉络膜动脉的扩张和 ACVs，从而降低成年后进一步出血的发生率。
