新型联合血管重建术对成人烟雾病患者认知功能的影响

Effect of new combined revascularization surgery on cognitive function of adult patients with moyamoya disease

目的探讨新型联合血管重建术对成人烟雾病患者认知功能的影响。方法共纳入2021年5月至2022年4月在航空总医院行颞浅动脉-大脑中动脉搭桥术+脑-硬脑膜-颞肌-动脉-骨膜瓣贴敷术的23例成人烟雾病患者,于术前和术后6个月行头部MRI、DSA和CT灌注成像并采用松岛分级系统进行侧支代偿分级,采用蒙特利尔认知评价量表(MoCA)北京版评估患者认知功能。结果23例患者术后MoCA总评分(t=4.132,P=0.000)以及视空间/执行功能(t=2.612,P=0.016)、记忆(t=5.144,P=0.000)、注意力(t=2.655,P=0.014)和定向力(t=2.105,P=0.047)分评分均增加。术后根据松岛分级系统,A级(供血区范围>大脑中动脉供血区2/3)12例、B级(供血区范围为大脑中动脉供血区的1/3~2/3)8例、C级(供血区范围<大脑中动脉供血区1/3)3例。不同松岛分级患者手术前后MoCA总评分差异具有统计学意义(F=4.096,P=0.032),仅松岛分级C级患者术后MoCA总评分低于B级患者(t=2.715,P=0.018)。13例(56.52%)术后认知功能改善(MoCA总评分改善率≥12%),分别为松岛分级A级10例、B级2例、C级1例,不同松岛分级患者认知功能改善率差异具有统计学意义(χ2=7.079,P=0.029),仅松岛分级A级认知功能改善率高于B级(Z=-2.543,P=0.011)。结论新型联合血管重建术可有效改善成人烟雾病患者的认知功能,特别是视空间/执行功能、记忆、注意力、定向力;整体认知功能的改善与术后侧支代偿范围有关。

Objective To explore the effect of new combined revascularization surgery on cognitive function in adult patients with moyamoya disease(MMD).MethodsFrom May 2021 to April 2022,a total of 23 adult with MMD underwent superficial temporal artery(STA)-middle cerebral artery(MCA)bypass surgery and encephalo-duro-myo-arterio-periosto-synangosis(EDMAPS)at Aviation General Hospital were enrolled.They underwent head MRI,DSA and CT perfusion(CTP)examinations before and 6 months after surgery,and were graded for collateral compensation by the Matsushima grading system.Cognitive function was evaluated by Montreal Cognitive Assessment(MoCA)Beijing version.ResultsTotal 23 patients had an increase in the MoCA total score(t=4.132,P=0.000),as well as the scores of visual space/executive ability(t=2.612,P=0.016),memory(t=5.144,P=0.000),attention(t=2.655,P=0.014)and directional ability(t=2.105,P=0.047).Based on the Matsushima grading system after surgery,there were 12 patients with grade A(2/3 of MCA blood supply area),8 with grade B(1/3-2/3 of MCA blood supply area),and 3with grade C(1/3 of MCA blood supply area).There was a statistically significant difference in the MoCA total score before and after surgery in patients with different Matsushima grading system(F=4.096,P=0.032).Further pairwise comparison showed that patients with Matsushima grade C had lower MoCA total score than that with grade B(t=2.715,P=0.018).There were 13 cases(56.52%)with postoperative cognitive function improvement(MoCA total score improvement rate≥12%),including 10 cases with Matsushima grade A,2 with grade B,and one with grade C.The difference in cognitive function improvement rate among cases with different Matsushima grade was statistically significant(χ~2=7.079,P=0.029),and only cognitive fuusions was higher than that in grade B(Z=-2.543,P=0.011).Cncotniocnl improvement rate in Matsushima grade ANew combined revascularization surgery can effectively improve the cognitive function of adult patients with MMD,especially their visual space/executive ability,memory,attention and directional ability.The improvement of overall cognitive function is related to the range of collateKrael yc owmoprednssation after surgery.