间接血管重建术治疗成人烟雾病

Appliction of encephalo-duro-arterio-synangiosis in treatment of adults Moyamoya disease

目的探讨脑-硬脑膜-血管融合术（EDAS）治疗成人烟雾病的临床疗效。方法回顾分析上海交通大学医学院附属瑞金医院北院神经外科2005年1月~2014年6月收治的25例成人烟雾病患者的临床资料。其中男性12例,女性13例,平均年龄42岁。以缺血为首发症状者19例,出血为首发症状者6例。根据Suzuki分型标准,Ⅲ期14例,Ⅳ期8例,Ⅴ期3例。术前常规行血管造影明确诊断。所有病例均接受EDAS手术。术后6个月复查DSA进行疗效评估。结果本组25例患者,行左侧EDAS手术9例,右侧EDAS手术16例。术后6个月复查,再次接受对侧EDAS手术3例。（1）新生血管生长：术后6个月DSA复查,25例患者中血管重建有效率为85.7%。（2）术后神经功能症状改善：术后6个月复查,采用改良Rankin量表（mRS）评分标准对25例患者进行神经功能评估,脑缺血组神经功能改善明显（P〈0.05）,脑出血组神经功能改善不明显（P〉0.05）。25例患者平均随访3.2年,1例缺血患者术后有短暂脑缺血发作,未伴有神经功能缺损表现;脑出血患者未有再出血发生。结论 EDAS创伤小,手术并发症少,对成人缺血型烟雾病有一定的疗效。

Objective To discuss clinical features and therapeutic effects of moyamoya disease treated by encephalo-duro-arterio-synangiosis（ EDAS）. Methods The clinical data of 25 patients with Moyamoya disease（ MMD） treated in our department from Journay 2005 June 2014 were analyzed retrospectively. All patients were adults,including 12 male and 13 female cases. Clinical presentation was ischemic in 19 patients and hemorrhagic in 6. According to Suzuki＇s criteria,14 patients were in stage 3,8 in stage 4 and 3 in stage 5. Indirect revascularization（ Encephalo-duroarterio-synangiosis,EDAS） was performed in all these patients,with 16 on the right side,9 on the left side,and 3 on the other side 6 months after first operation. Cerebral angiogram,as well as mRS score,were reviewed and compared preoperatively and postoperatively（ 6 months） to determine operative effects. Results The improvement rate of blood flow was 85. 7% on the operated hemisphere at postoperative DSA examination 6 months later. Neurological function showed significant improvement in ischemic type patients（ P〈0. 05） 6 months postoper-atively,but not in hemorrhagic type patients（ P〉0. 05）. The patients were followed up for median 3. 2 years and one patient in ischemic group experienced TIA. No patient suffered from hemorrhage in the hemorrhagic group. Conclusion Indirect revascularization by EDAS is a simple,minimal invasive and effective technique for treatment of adult MMD.