Multiple burr-hole operation for adult moyamoya disease
Multiple burr-hole operation for adult moyamoya disease
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DOI：
10.3171/jns.1996.84.3.0468
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发表时间：
1996-03-01
影响因子：
4.1
通讯作者：
Tamaki, N
中科院分区：
文献类型：
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作者：
Kawaguchi, T;Fujita, S;Tamaki, N
本研究报告了成人烟雾病多次钻孔手术的良好结果。10名患者在每个半球钻了1 - 4个钻孔（平均2.1个）。在4例患者中，在使用N-异丙基-p-[I-123]碘苯丙胺进行脑的随访单光子发射计算机断层扫描成像检测到脑血流（CBF）下降后，在对侧添加了新的钻孔。术后随访6 ~ 62个月，平均34.7个月。从术后6个月开始，血管造影显示43个钻孔中有41个钻孔有丰富的新生血管，首先来自脑膜中动脉，然后来自颞浅动脉，两个钻孔没有新生血管，分别有硬膜下积液和局部脑萎缩。6例患者的主要血管狭窄进展。4例患者的6个部位烟雾血管减少。CBF研究显示，所有6例受试患者对乙酰唑胺的反应性均有所改善。所有6例出现此症状的患者的短暂性脑缺血发作均消失，2例出现脑梗死的患者和2例脑室内出血的患者的术前症状均改善。随访期间无死亡或发病，无新的神经功能缺损或再出血。作者强烈推荐多个钻孔手术作为成人烟雾病的首选手术治疗方法，因为它安全有效。
Excellent results from multiple burr-hole operations for adult moyamoya disease are reported in this study. Ten patients had between one and four burr holes (mean 2.1) drilled in each hemisphere. In four patients new burr holes were added on the opposite side after depression of cerebral blood flow (CBF) was detected by follow-up single-photon emission computerized tomography imaging of the brain with N-isopropyl-p-[I-123]iodoamphetamine. The postoperative follow-up period ranged from 6 to 62 months (mean 34.7 months). Beginning at 6 months postsurgery, angiograms disclosed rich neovascularization at 41 of 43 bun holes, first from the middle meningeal artery, then fi om the superficial temporal artery.Neovascularization did not occur at two burr holes at which there was subdural effusion and local cerebral atrophy, respectively. Progression of stenosis of the major vessels was seen in six patients. Moyamoya vessels were decreased at six sites in four patients. The CBF study revealed that the reactivity to acetazolamide improved in all six patients tested. Transient ischemic attacks disappeared in all six patients presenting with this symptom, and preoperative symptoms improved in both of the patients who presented with cerebral infarction and in both patients with intraventricular hemorrhage. There was no mortality or morbidity, and no new neurological deficits or rebleeding developed during the followup period. The authors strongly recommend the multiple burr-hole operation as the surgical treatment of choice for adult moyamoya disease because of its safety and effectiveness.