Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China; People's Hospital of Huazhou, Maoming City, Guangdong Province, China.
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
World Neurosurg. 2022 Aug;164:276-280. doi: 10.1016/j.wneu.2022.05.071. Epub 2022 May 23.
The objective of this study was to conduct a retrospective analysis of the safety and efficacy of one-session treatment with cranioplasty and superficial temporal artery-middle cerebral artery (STA-MCA) bypass after decompressive craniectomy in hemorrhagic moyamoya disease (MMD).
From March 2019 to August 2021, 5 patients with hemorrhagic MMD after DC were admitted in Nanfang Hospital. All patients underwent digital subtraction angiography to exclude any spontaneous revascularization between the cortex and temporal muscle and the preservation of STA. Then one-stage treatment with STA-MCA bypass and cranioplasty were performed. If no suitable recipient artery was available, an encephalo-myo-synangiosis procedure was used as a salvage plan.
Four patients underwent direct STA-MCA bypass, while one underwent encephalo-myo-synangiosis due to absence of a suitable recipient artery. All patients had no hemorrhage on postoperative computed tomography, and no new infarcts were detected on magnetic resonance imaging. There were no new recurrent symptoms at clinical follow-up 8 to 24 months after surgery. Three patients had improved Glasgow Outcome Scale scores, and 2 patients had stable Glasgow Outcome Scale scores. Perfusion computed tomography showed improvement in cerebral hemodynamics. Four follow-up digital subtraction angiographies were performed, suggesting graft patency.
One-session treatment with extracranial to intracranial bypass and cranioplasty are safe and effective in patients with MMD who have undergone previous decompressive craniectomy due to hemorrhagic attack.
本研究旨在对出血性烟雾病（MMD）患者行去骨瓣减压术后一次性行颅骨修补和颅外-颅内动脉搭桥术（STA-MCA 旁路）治疗的安全性和疗效进行回顾性分析。
2019 年 3 月至 2021 年 8 月，南方医院收治了 5 例 DC 后并发出血性 MMD 的患者。所有患者均行数字减影血管造影术（DSA），以排除皮层与颞肌之间和 STA 之间自发再血管化的可能性，并保留 STA。然后行 STA-MCA 旁路和颅骨修补术一期治疗。如果没有合适的受体动脉，则采用脑肌血管融通术（EMAS）作为挽救方案。
4 例患者行直接 STA-MCA 旁路术，1 例因无合适受体动脉而行 EMAS。所有患者术后 CT 未见出血，磁共振成像（MRI）未见新发梗死。术后 8 至 24 个月临床随访时无新发复发性症状。3 例患者格拉斯哥预后量表（GOS）评分改善，2 例患者 GOS 评分稳定。灌注 CT 显示脑血流动力学改善。4 例行随访 DSA 检查，提示移植血管通畅。
对于因出血性卒中而行去骨瓣减压术的 MMD 患者，一次性行颅外-颅内旁路和颅骨修补术是安全有效的。
