Houkin K, Kamiyama H, Abe H, Takahashi A, Kuroda S
Department of Neurosurgery, Hokkaido University School of Medicine, Sapporo, Japan.
Stroke. 1996 Aug;27(8):1342-6. doi: 10.1161/01.str.27.8.1342.
It is well recognized that revascularization surgery using direct and/or indirect bypass provides effective surgical management for pediatric moyamoya disease. However, surgical treatment of the adult hemorrhagic type remains controversial. In this study, the effect of surgery for adult moyamoya disease was investigated.
We analyzed 35 patients with adult moyamoya disease (patient age, over 20 years), 24 patients with initial onset of intracerebral hemorrhage, and 11 patients with initial onset of cerebral ischemia who underwent both direct bypass surgery of the superficial temporal artery to the middle cerebral artery anastomosis and indirect revascularization of encephalo-duro-arteriomyo-synangiosis.
Of 24 patients with hemorrhagic-type disease, 3 showed rebleeding: of 11 patients with the ischemic type, 2 showed intracerebral hemorrhage after surgery. Overall, 5 of 35 patients (14.3%) had hemorrhage after revascularization surgery (mean follow-up period, 6.4 years). Postoperative angiography revealed that direct anastomosis is effective whereas indirect revascularization is not always effective for adult moyamoya disease. Moyamoya vessels, which are supposed to be responsible for hemorrhage, decreased in 25% of patients.
Revascularization surgery cannot always prevent rebleeding. However, a decrease in moyamoya vessels was induced by surgery, which may reduce the risk of hemorrhage more effectively than conservative treatment. In cases of adult moyamoya disease, direct bypass is particularly important, since the indirect revascularization is not as useful in adult cases as in pediatric cases.
众所周知，采用直接和/或间接搭桥的血管重建手术可为小儿烟雾病提供有效的手术治疗。然而，成人出血型烟雾病的手术治疗仍存在争议。在本研究中，我们对成人烟雾病手术的效果进行了调查。
我们分析了35例成人烟雾病患者（患者年龄超过20岁），其中24例首发脑出血，11例首发脑缺血，这些患者均接受了颞浅动脉至大脑中动脉吻合的直接搭桥手术以及脑-硬脑膜-动脉-肌-血管融合术的间接血管重建手术。
在24例出血型疾病患者中，3例出现再出血；在11例缺血型患者中，2例术后出现脑出血。总体而言，35例患者中有5例（14.3%）在血管重建手术后出现出血（平均随访期为6.4年）。术后血管造影显示，直接吻合术有效，而间接血管重建术对成人烟雾病并不总是有效。被认为是出血原因的烟雾状血管在25%的患者中减少。
血管重建手术并非总能预防再出血。然而，手术可使烟雾状血管减少，这可能比保守治疗更有效地降低出血风险。在成人烟雾病病例中，直接搭桥尤为重要，因为间接血管重建术在成人病例中不如在小儿病例中有用。
