Aoki N
Department of Neurosurgery, Tokyo Metropolitan Ohkubo Hospital, Japan.
Surg Neurol. 1993 Nov;40(5):372-7. doi: 10.1016/0090-3019(93)90215-m.
While the efficacy of cerebrovascular bypass surgery for Moyamoya disease with ischemic events has been substantiated, the surgical indication for the patients presenting with intracranial hemorrhage is as yet undetermined. In an effort to prevent rebleeding from rupture of Moyamoya vessels, seven patients with intracranial hemorrhage underwent indirect bypass surgery. During the follow-up period between 2 and 11 years (mean 4.9 years), one patient suffered rebleeding 5 years after bypass surgery. Follow-up cerebral angiography failed to show revascularization and reduction of moyamoya vessels in all but one of seven patients. Thus, the author's experience suggests that bypass surgery for Moyamoya disease with hemorrhage is angiographically far less successful compared to that with ischemia. A review of the series including patients with angiographically successful revascularization and reduction of Moyamoya vessels failed to demonstrate the definitive effectiveness in eliminating the risk of further intracranial hemorrhage.
虽然脑血管搭桥手术对伴有缺血性事件的烟雾病的疗效已得到证实，但颅内出血患者的手术指征尚未确定。为防止烟雾病血管破裂再出血，7例颅内出血患者接受了间接搭桥手术。在2至11年（平均4.9年）的随访期内，1例患者在搭桥手术后5年发生再出血。除7例患者中的1例之外，随访脑血管造影未能显示其余患者血管再通和烟雾病血管减少。因此，作者的经验表明，与缺血性烟雾病相比，出血性烟雾病的搭桥手术在血管造影方面的成功率要低得多。对血管造影显示血管再通成功且烟雾病血管减少的患者系列进行回顾，未能证明在消除进一步颅内出血风险方面的确切有效性。
