改良EDAS联合颞浅筋膜贴敷-硬脑膜翻转手术精准治疗缺血性脑血管病的疗效分析

Efficacy of modified encephalo-duro-arterio-synangiosis combined with superficial temporal fascia attachment-dural reversal surgery in precise treatment of ischemic cerebrovascular disease

目的探讨改良脑-硬膜-动脉血管融通术(EDAS)联合颞浅筋膜贴敷-硬脑膜翻转手术治疗缺血性脑血管病的疗效。方法回顾性分析新疆医科大学第二附属医院神经诊疗中心自2018年12月至2020年6月收治的24例缺血性脑血管患者临床资料,所有患者均采用改良EDAS联合颞浅筋膜贴敷-硬脑膜翻转手术治疗。术后3个月时门诊复查患者头颅CT灌注成像(CTP),了解颅内脑血流灌注情况;术后6个月时复查患者头颅DSA,观察侧支循环建立情况。采用改良Rankin量表(mRS)评分评价术后6个月时患者预后良好率,mRS评分≤2分定义为预后良好。结果24例患者术前脑血流量(CBF)、局部血流达峰时间(rTTP)及局部平均通过时间(rMTT)分别为(26.91±8.77)mL/(100 g·min)、17.57(15.30,19.55)s、7.89(6.39,1.45)s,术后3个月时CBF、TTP及rMTT分别为(33.74+11.23)mL/(100 g·min)、16.22(13.84,18.44)s、6.16(5.20,10.38)s,差异均有统计学意义(P<0.05)。术后6个月时复查头颅DSA可见所有患者颅内外侧支循环建立。术后6个月时患者预后良好率为87.5%。结论改良EDAS联合题浅筋膜贴敷-硬脑膜翻转手术治疗缺血性脑血管病安全有效,可明显增加术区侧支循环建立,改善患者预后。

Objective To investigate the efficacy of modified cnccphalo-duro-artcrio-synangiosis(EDAS)combined with superficial temporal fascia attachment-dural reversal surgery in treatment of ischemic cerebrovascular diseases.Methods Twenty-four patients with ischemic cerebrovascular diseases,admitted to our hospital from December 2018 to June 2020,were selected.Their clinical data were retrospectively analyzed.All patients were treated by modified EDAS combined with superficial temporal fascia attachment-dural reversal surgery.CT cerebral perfusion(CTP)was re-examined 3 months after surgery to detect intracranial cerebral blood flow perfusion.Cephalic DSA was re-examined 6 months after surgery to observe the collateral circulation.Modified Rankin scale(mRS)was used to evaluate the good prognosis rate 6 months after surgery(mRS scores≤2 was defined as good prognosis).Results Preoperative cerebral blood flow(CBF),time to peak of regional blood flow(rTTP),and regional mean transit time(rMTT)of 24 patients were(26.91±8.77)mL/(1OO g·min),17.57(15.30,19.55)s and 7.89(6.39,11.45)s;3 months after surgery,the CBF,rTTP and rMTT were(33.74±11.23)mL/(100 g·min),16.22(13.84,18.44)s,6.16(5.20,10.38)s;significant differences were noted between the preoperative indexes and indexes 3 months after surgery(P<O.O5).Re-examination of the cranial DSA 6 months after surgery showed successful establishment of intracranial collateral circulation in all patients,and the good prognosis rate 6 months after surgery was 87.5%.Conclusion Modified EDAS combined with superficial temporal fascia attachment-dural reversal surgery is an effective method for ischemic cerebrovascular diseases,which can significantly increase the establishment of collateral circulation in the surgical area and prognosis of ischemic cerebrovascular diseases.