Yomo Munetaka, Kitai Ryuhei, Tada Hiroyuki, Isozaki Makoto, Higashino Yoshifumi, Matsuda Ken, Yamauchi Takahiro, Akazawa Ayumi, Kawajri Satoshi, Oiwa Mizuki, Yamada Shintaro, Tsubota Tadahiro, Watanabe Akifumi, Okazawa Hidehiko, Kiyono Yasushi, Arishma Hidetaka, Kikuta Kenichiro
Division of Medicine, Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Department of Neurosurgery, Kaga Medical Center, Kaga, Japan.
Front Neurol. 2023 Oct 6;14:1269400. doi: 10.3389/fneur.2023.1269400. eCollection 2023.
This study aimed to examine the effect of newly developed scissors-attached micro-forceps in superficial temporal artery-to-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease (MMD).
Of 179 consecutive STA-MCA anastomoses on 95 hemispheres of 71 MMD patients at the University of Fukui Hospital between 2009 and 2023, 49 anastomoses on 26 hemispheres of 21 patients were enrolled in this retrospective cohort clinical trial intraoperative indocyanine green video-angiography did not demonstrate bypass patency in three anastomoses in two patients who were excluded. Twenty-one anastomosis in 19 hemispheres of 16 patients were performed using the conventional micro-forceps (conventional group, CG), and 25 anastomoses in 22 hemispheres of 19 patients were performed using scissors-attached micro-forceps (scissors group, SG). A small infarction near the anastomotic site detected using postoperative diffusion-weighted imaging was defined as anastomotic site infarction (ASI). Factors affecting the occurrence of ASI were examined by univariate, logistic regression, and receiver operating curve (ROC) analysis.
There were no significant differences in clinical parameters such as age, sex, number of sacrificed branches, number of sacrificed large branches, and number of sutures between the CG and SG. However, the clamp time and occurrence of ASI were significantly lower in the SG than in the CG. Logistic regression analysis revealed that the clamp time was the only significant factor predicting the occurrence of ASI. A receiver operating curve analysis also revealed that the clamp time significantly predicted the occurrence of ASI (area under the curve, 0.875; cutoff value, 33.2 min).
The newly developed scissors-attached micro-forceps could significantly reduce the clamp time and occurrence of ASI in STA-MCA anastomosis for MMD.
本研究旨在探讨新开发的附有剪刀的微型镊子在烟雾病（MMD）的颞浅动脉-大脑中动脉（STA-MCA）吻合术中的效果。
在2009年至2023年期间，福井大学医院对71例MMD患者的95个半球进行了179次连续的STA-MCA吻合术，本回顾性队列临床试验纳入了21例患者26个半球的49次吻合术。术中吲哚菁绿血管造影显示，2例患者的3次吻合术未显示搭桥通畅，这2例患者被排除。16例患者19个半球的21次吻合术使用传统微型镊子（传统组，CG），19例患者22个半球的25次吻合术使用附有剪刀的微型镊子（剪刀组，SG）。术后弥散加权成像检测到的吻合口附近小梗死定义为吻合口梗死（ASI）。通过单因素、逻辑回归和受试者工作特征曲线（ROC）分析来研究影响ASI发生的因素。
CG组和SG组在年龄、性别、牺牲分支数量、牺牲大分支数量和缝合数量等临床参数方面无显著差异。然而，SG组的夹闭时间和ASI发生率显著低于CG组。逻辑回归分析显示，夹闭时间是预测ASI发生的唯一显著因素。ROC分析还显示，夹闭时间能显著预测ASI的发生（曲线下面积为0.875；临界值为33.2分钟）。
新开发的附有剪刀的微型镊子可显著减少MMD的STA-MCA吻合术中的夹闭时间和ASI的发生。
