Department of Neurosurgery, Myong-Ji St. Mary's Hospital, Seoul, South Korea.
Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
World Neurosurg. 2023 Dec;180:e99-e107. doi: 10.1016/j.wneu.2023.08.094. Epub 2023 Aug 28.
The purpose of this study was to analyze factors affecting good neovascularization after indirect bypass surgery.
From August 2000 to July 2020, postoperative image results and medical records of 132 patients (159 hemispheres) who underwent EDAS of indirect bypass surgery at two institutions were reviewed retrospectively. Based on DSA results, angiogenesis after indirect bypass was divided into "good" or "poor" according to the Matsushima criteria. STA flap length affecting GPN were analyzed in the entire group (n = 159) and a MMD group (n = 134).
In the entire group, GPN after EDAS was observed in 94 (59.1%) hemispheres. Age, MMD, hypertension, and bone flap size were identified as significant factors in univariate analysis. Also, in the MMD group, 86 (64.2%) hemispheres showed GPN. Hypertension and bone flap size were significant factors in both univariate and multivariate analyses. Cutoff values of bone flap size and GPN were 47.91 cm in the entire group and the MMD group.
In all patients who received EDAS, good postoperative neovascularization was significant in those with a young age, MMD, without hypertension, and large bone flap size. No hypertension and large bone flap size were meaningful factors in the MMD group. AUROC showed that an appropriate bone flap size was 47.91 cm. However, a further controlled prospective study is needed.
本研究旨在分析影响间接旁路手术后良好血管新生的因素。
回顾性分析 2000 年 8 月至 2020 年 7 月在 2 家机构行 EDAS 间接旁路手术的 132 例患者（159 侧半球）的术后影像学结果和病历资料。根据 DSA 结果，按照松田标准将间接旁路术后血管生成分为“良好”或“不良”。分析影响整个组（n=159）和 MMD 组（n=134）间接旁路术后 GPN 的 STA 皮瓣长度。
在整个组中，EDAS 后 GPN 可见于 94 个（59.1%）侧半球。年龄、MMD、高血压和骨瓣大小在单因素分析中被确定为显著因素。此外，在 MMD 组中，86 个（64.2%）侧半球显示 GPN。高血压和骨瓣大小在单因素和多因素分析中均为显著因素。整个组和 MMD 组中骨瓣大小和 GPN 的截断值分别为 47.91cm。
在接受 EDAS 的所有患者中，年轻、MMD、无高血压和大骨瓣大小与术后良好血管新生显著相关。无高血压和大骨瓣大小是 MMD 组的有意义因素。AUROC 显示，合适的骨瓣大小为 47.91cm。但是，还需要进一步进行控制前瞻性研究。
