儿童烟雾病颅骨多点钻孔术后局部脑血流的变化

Hemodynamic Change of Childhood Moyamoya Disease after Multiple Burr-hole Operation

目的观察儿童烟雾病(Moyamoya病)患者颅骨多点钻孔术手术前后钻孔处新生血管生长情况及局部脑血流变化情况,评价儿童Moyamoya病患者颅骨多点钻孔术手术效果,并选择出最佳的随访方法。方法儿童Moyamoya病患者8例,采用颅骨多点钻孔术进行治疗,彩色多普勒超声测定新生血管情况,单光子发射计算机断层摄影(SPECT)测定局部脑血流量。比较术前、术后1周及术后3～6个月新生血管、局部脑血流量的变化。结果颅骨多点钻孔术后1周颅骨钻孔处开始血管生长,术后3个月钻孔处新生血管丰富,SPECT随访可见钻孔处脑局部血流量均有改善,而未行颅骨钻孔的大脑半球脑局部血流量较术前降低;所有患者术后缺血症状较术前均有明显改善。结论儿童Moyamoya病患者行颅骨多点钻孔术后,可以看到新生血管形成及局部脑血流量增加,且患者症状均有改善,提示颅骨多点钻孔手术可能有助于治疗儿童Moyamoya病患者;彩色多普勒超声可以成为Moyamoya病手术后动态观察脑血流改善的有效的、无创的随访检查手段。

Objective Using multicolor ultraphonic power Doppler to study the hemodynamic change of childhood moyamoya disease after multiple burr-hole operation, to know the effectiveness of the multiple burr-hole operation and to choose the best device of follow-up. Methods Eight children diagnosed with moyamoya disease underwent multiple burr-hole operations. And we used multicolor ultraphonic power Doppler assisting with single photon emission computed tomography (SPECT) to observe the hemodynamic change before and after the operations. Results Beginning at one week after operation, angiograms showed neovascularization, and 3 months after operation showed rich neovascularization. SPECT showed that the regional cerebral blood ? ow(rCBF) of homolateral hemisphere was improved at 3 months after burr-hole operation, but rCBF of opposite hemisphere decreased when compared with preoperation. Ischemic symptoms of all the patients improved after burr-operation. Conclusion After burr-hole operation, we can fi nd rich new vessels and lateral branches through the holes. The burr-hole operation can improve the ischemia of childhood moyamoya disease; Doppler imaging is a valid noninvasive alternative to carotid artery angiography in evaluating direct and indirect revascularization.