Fujimura Miki, Ito Masaki, Uchino Haruto, Kawabori Masahito, Sugiyama Taku
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Acta Neurochir Suppl. 2025;136:99-104. doi: 10.1007/978-3-031-89844-0_12.
Revascularization surgery such as superficial temporal artery-middle cerebral artery (STA-MCA) bypass is a standard management choice for symptomatic moyamoya disease (MMD) patients, with either ischemic or hemorrhagic presentation. We sought to clarify the efficacy and safety of institutional standardized revascularization procedures for MMD.
The present study includes 37 consecutive patients with MMD (2-60 years old, 42.0 on average) undergoing revascularization surgery on 42 affected hemispheres. Direct-indirect combined revascularization surgery was performed on most hemispheres (41/42, 97.6%), including STA-MCA bypass (39 hemispheres) and occipital artery-posterior cerebral artery bypass (2 hemispheres). All patients underwent standardized perioperative management with strict blood pressure control (110-130 mmHg) based on routine single-photon emission computed tomography (SPECT) 1 and 7 days after surgery. Then we investigated the outcome of surgeries, focusing mainly on that of combined revascularization procedures.
The outcome of 42 surgeries was favorable in all cases, except for one adult (2.3%) manifesting with cerebral hyperperfusion syndrome leading to neurological worsening. None of the patients developed perioperative cerebral infarction (0/42; 0%), and the patency of the direct bypass was confirmed via MRA in all patients undergoing combined procedure (41/41, 100%). Two patients suffered wound-healing delay, one of which required resuture.
The combined revascularization surgery is a safe and effective treatment for MMD, while local cerebral hyperperfusion is a potential complication that should be avoided through intensive perioperative care.
血管重建手术，如颞浅动脉-大脑中动脉（STA-MCA）搭桥术，是有症状的烟雾病（MMD）患者（无论是缺血性还是出血性表现）的标准治疗选择。我们试图阐明MMD机构标准化血管重建手术的疗效和安全性。
本研究纳入了37例连续的MMD患者（年龄2至60岁，平均42.0岁），对42个患侧半球进行了血管重建手术。大多数半球（4l/42，97.6%）实施了直接-间接联合血管重建手术，包括STA-MCA搭桥术（39个半球）和枕动脉-大脑后动脉搭桥术（2个半球）。所有患者均接受标准化围手术期管理，术后1天和7天根据常规单光子发射计算机断层扫描（SPECT）严格控制血压（110-130mmHg）。然后我们调查了手术结果，主要关注联合血管重建手术的结果。
42例手术的结果均良好，除1例成年人（2.3%）出现脑过度灌注综合征导致神经功能恶化。没有患者发生围手术期脑梗死（0/42；0%），所有接受联合手术的患者通过磁共振血管造影（MRA）证实直接搭桥通畅（41/41，100%）。2例患者伤口愈合延迟，其中1例需要再次缝合。
联合血管重建手术是治疗MMD的一种安全有效的方法，而局部脑过度灌注是一种潜在的并发症，应通过强化围手术期护理来避免。
