改良间接血管重建治疗缺血性烟雾病

Modified indirect revascularization for the treatment of ischemic moyamoya disease

目的探讨改良脑-硬膜-动脉融合术（EDAS）治疗缺血性烟雾病的疗效。方法回顾性分析21例缺血性烟雾病病人的临床资料。其中单侧缺血性烟雾病6例，双侧缺血性烟雾病15例，病人经CTA、MRA或DSA检查证实。行双侧改良EDAS术12例。单侧改良EDAS术9例。结果本组手术均顺利。硬脑膜内层病理检查提示：存在炎症反应15例，未见异常6例。术后出现硬脑膜下积液l例。16例病人随访3-12个月，无短暂性脑缺血发作和脑卒中发生；行DSA复查13例，颅底异常血管明显减少10例。无明显变化3例。结论改良EDAS术安全、微创，治疗缺血性烟雾病近期效果良好，远期疗效有待于进一步随访。

Objective To discuss the therapeutic efficacy of modified encephal （EDAS） for the treatment of ischemic moyamoya disease. Methods Clinical data of 21 patients with ischemic moyamoya disease were analyzed retrospectively, including unilateral lesion in 6 cases and bilateral lesions in 15, which were verified by CTA, MRA or DSA. The bilateral modified EDAS was performed in 12 patients and unilateral modified EDAS in 9. Results The surgical procedures were all successful. The pathological examination of inner dural layers indicated inflammatory response in 15 cases and no abnormality in 6. Subdural effusion occurred in 1 ease after surgery. Sixteen patients were followed up for 3 to 12 months, and no transient ischemic attack or cerebral stroke occurred. DSA reexamination were performed in 13 cases, and the abnormal vessels of skull base significantly reduced in 10 cases and no obvious change was seen in 3. Conclusions Modified EDAS is safe and minimally invasive, and its short-term effect is good for the ischemic moyamoya disease, but its long-term outcome needs to be observed further.