Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium.
Medical Imaging Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium.
Acta Neurochir (Wien). 2023 Dec;165(12):3613-3622. doi: 10.1007/s00701-023-05876-0. Epub 2023 Nov 22.
This study is aimed at analyzing clinical outcome, absence of stroke recurrence, revascularization, and complications and long-term follow-up in the surgical treatment of moyamoya angiopathy (MMA) using the multiple burr holes (MBH) technique with dura opening and arachnoid preservation as a single procedure. To the best of our knowledge, this is the first to describe an MBH technique with arachnoid preservation.
We retrospectively reviewed all patients operated from June 2001 to March 2021, for a symptomatic and progressive MMA operated with opening of the dura but arachnoid preservation. Clinical examinations were obtained in all patients, and radiological monitoring was performed by cerebral 3D-magnetic resonance angiography (MRA) with perfusion or single-photon emission computed tomography (SPECT) with acetazolamide.
In total, 21 consecutive patients (6 children and 15 adults) were included with a mean age of 7.4 years in the pediatric group and 36.9 years in the adult group. Initial presentation was permanent ischemic stroke in 15 cases, transient ischemic attack (TIA) in 5 cases, and cerebral hemorrhage in one case. The MBH with dura opening and arachnoid preservation was performed bilaterally in 9 cases (43%) and unilaterally in 12 cases (57%). One patient died due to intraoperative bilateral ischemic stroke. Of the 20 other patients, 30% demonstrated clinical stability and 70% showed partial or complete recovery. Although one patient experienced a perioperative stroke, we did not observe any pseudomeningocele or postoperative ischemic stroke (IS) recurrence in all surviving cases during the average follow-up period of 55.5 months (range: 1-195). These outcomes emphasize the importance of preoperative monitoring to ensure the effectiveness and safety of the intervention. Postoperative angiography studies showed revascularization in 96.3% of treated hemispheres (100% in the adult group vs 80% in the pediatric group).
Our results on this small cohort suggest that the MBH technique with opening of the dura and arachnoids preservation can prevent recurrent strokes and reduce the risk of pseudomeningocele.
本研究旨在分析使用开颅并保留蛛网膜的多孔骨窗（MBH）技术对烟雾病（MMA）进行单一手术治疗的临床结果、无中风复发、血运重建和并发症以及长期随访情况。据我们所知，这是首次描述一种开颅并保留蛛网膜的 MBH 技术。
我们回顾性分析了 2001 年 6 月至 2021 年 3 月期间因症状性和进行性 MMA 而行开颅但保留蛛网膜的所有患者。对所有患者进行临床检查，并通过脑 3D 磁共振血管造影（MRA）伴灌注或单光子发射计算机断层扫描（SPECT）伴乙酰唑胺进行放射影像学监测。
共纳入 21 例连续患者（6 例儿童和 15 例成人），儿童组平均年龄为 7.4 岁，成人组平均年龄为 36.9 岁。首发表现为 15 例永久性缺血性中风、5 例短暂性脑缺血发作（TIA）和 1 例脑出血。9 例（43%）行双侧 MBH 开颅并保留蛛网膜，12 例（57%）行单侧 MBH 开颅并保留蛛网膜。1 例患者因术中双侧缺血性中风死亡。在其余 20 例患者中，30%表现为临床稳定，70%表现为部分或完全恢复。尽管 1 例患者在围手术期发生中风，但在平均 55.5 个月（范围：1-195）的随访期间，所有存活患者均未出现假性脑膜膨出或术后中风（IS）复发。这些结果强调了术前监测的重要性，以确保干预的有效性和安全性。术后血管造影研究显示，治疗半球的血运重建率为 96.3%（成人组为 100%，儿童组为 80%）。
我们对这一小队列的研究结果表明，开颅并保留蛛网膜的 MBH 技术可以预防中风复发，降低假性脑膜膨出的风险。
