微创联合血管重建术治疗成人缺血型烟雾病

Treatment of adult ischemic moyamoya disease by combined revascularization via a minimized approach

目的探讨微创颞浅动脉-大脑中动脉吻合术(STA-MCA)结合硬膜翻转术治疗成人缺血型烟雾病的疗效。方法回顾性分析2013年3月-2016年3月54例行微创STA-MCA结合硬膜翻转术的成人缺血型烟雾病患者的临床及随访资料。结果行单侧手术41例,双侧手术13例,手术顺利,STA-MCA吻合通畅,患者手术侧血流灌注均有立即改善;1例患者术后出现一过性口齿不清,1例术后出现症状性过度灌注,其余患者围手术期无并发症;随访3月~3年,预后良好,DSA示搭桥血管充盈良好,烟雾状血管有不同程度的减少,侧支循环建立良好。结论微创联合血管重建术并发症少,手术疗效良好,远期疗效有待于进一步随访。

Objective To discuss the therapeutic efficacy of anastomosis of superficial temporal artery to middle cerebral artery （STA-MCA） combined with dural reversion in treatment of adult ischemic moyamoya disease via a minimized approach. Methods Totally 54 adult patients with ischemic moyamoya disease operated on with minimal invasion combined revascularization from March 2013 to March 2016 were reported. Their data were retrospectively collected from the patient records. Follow-up data were updated by telephone interview or outpatient service. Results Unilateral surgical procedure was performed in 41 patients and bilateral surgical procedure was performed in 13 patients successfully, the cerebral blood flow increased immediately after operation. Transient lisp and excessive perfusion occurred in 2 cases after surgery, other patients had no complication in the perioperative period. Follow-up of 3 months-3 years showed all bypasses remained open, most of the patients had good prognosis. Conclusions Minimal invasion combined revascularization is safe and effective, and its short-term effect is good for the adult ischemic moyamoya disease, but its long-term outcome needs to he further observed.