改良型多处小骨窗开颅硬脑膜翻转并肌骨膜贴敷术治疗烟雾病21例

Technical modified procedure of indirect revascularization for the treatment of MMD using multiple bone windows and retroposition, dura inversion, muscle-pericranium flap, synangiosis： 21 cases report

目的探讨改良型间接血管重建术——多处小骨窗开颅并骨瓣回置硬脑膜翻转并肌骨膜贴敷术治疗烟雾病（MMD）的临床疗效。方法21例烟雾病患者接受改良型多处颅骨小骨窗开颅硬脑膜翻转并肌骨膜贴敷术治疗，术后门诊复查、电话随访及脑血管造影复查随访6～70个月，平均26．6个月。结果①临床症状改善情况：参照评估标准：优秀8例，良好12例，一般1例，无患者症状加重，有效率为95．2％。②血运改善情况：8例患者行DSA复查，术区均有新生血管向颅内生长，新生血管来自脑膜中动脉和颞浅动脉，缺血区血运改善。③并发症：少量硬脑膜下血肿2例，自行吸收；暂时性神经功能障碍6例；发热1例；少量硬脑膜下积液1例，出院前恢复。术后无癫痫发作，无术后脑脊液漏。结论改良型多处小骨窗开颅硬脑膜翻转并肌骨膜贴敷术可治疗烟雾病，且存在自己的优点。

Objective To investigate the efficacy of technical modified procedure of indirect revascularization using muhiple bone windows and retroposition, dura inversion, musele-pericranium flap, synangiosis（ eneephalo-duro- myo-perieranium-synangiosis,EDMPS） for the treatment of moyamoya diseasec （MMD）. Methods The EDMPS surgery was performed on 32 hemispheres in 21 patients. The follow-up period ranged from 6 to 70 months （ mean = 26.6 months） ,which include out-patient recheck, telephone follow-up and digital subtraction angiography. Results The results were assessed for clinical improvement, angiographic revascularization：（1）Clinical improvement： in accordance with appraisal standard 8 patients had excellent surgical outcomes,twelve patients had good outcomes,one had common outcomes, none get worse, effective power was 95.2%. （2）Angiographic revaseularization： eight patients accepted postoperatively angiography, the extent of revascularization evidence on external carotid angiograms was obviously. Promoting neoangiogenesis inducing collateral vessel formation and restoring peffusion to oxygen-deprived areas of the brain had been found in all 8 patients. （3） Postoperatively complication： small quantity of subdural hematoma were observed in 2 patients and which were auto absorbed, transient ischemie attack were observed in 6 patients,one fervescence, one small quantity of subdural collection of fluid and recovery prior to discharge, no postoperatively epileptic attack, no cerebrospinal fluid leak. Conclusion The EDMPS is effective surgical modalities for the treatment of MMD and suggests its typical clear advantages.