Efficacy of superficial temporal artery-middle cerebral artery anastomosis with routine postoperative cerebral blood flow measurement during the acute stage in childhood moyamoya disease
Efficacy of superficial temporal artery-middle cerebral artery anastomosis with routine postoperative cerebral blood flow measurement during the acute stage in childhood moyamoya disease
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DOI：
10.1007/s00381-007-0551-y
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发表时间：
2008-07-01
影响因子：
1.4
通讯作者：
Tominaga, Teiji
中科院分区：
文献类型：
--
作者：
Fujimura, Miki;Kaneta, Tomohiro;Tominaga, Teiji
目的 烟雾病的手术血运重建通过改善脑血流量（CBF）来预防脑缺血发作。然而，CBF的快速增加如何影响儿童烟雾病急性期的慢性缺血性大脑尚未确定。 材料和方法本研究包括连续9例儿童烟雾病患者（2例与8岁相似，平均6.2例），这些患者接受了17个大脑半球的颞浅动脉-大脑中动脉（STA-MCA）吻合术。我们前瞻性地在 17 次手术后 1 天和 7 天进行了单光子发射计算机断层扫描。随访时间12～37个月，平均24.9个月。 结果 17例手术效果为优（短暂性脑缺血发作消失）14个半球（82.4%），良（短暂性脑缺血发作减少）3个半球（17.6%）。除1例患者（5.9%）在亚急性期表现为STA-MCA旁路供血的部分大脑皮层出现假板层坏死外，无患者发生围手术期梗死，但未影响其长期神经功能状态。一名患者 (5.9%) 由于过度灌注而出现短暂性面瘫，但数天内痊愈。随访期间没有患者出现永久性神经功能恶化。结论 STA-MCA 吻合术是治疗儿童烟雾病的一种安全有效的方法。我们建议常规 CBF 测量，以避免手术并发症，包括脑缺血和过度灌注。
Object Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). It is undetermined, however, how rapid increase in CBF affects chronic ischemic brain during the acute stage in childhood moyamoya disease.Materials and methods The present study includes nine consecutive cases of patients with childhood moyamoya disease (2 similar to 8 years old, 6.2 in average), who underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis on 17 hemispheres. We prospectively performed single-photon emission computed tomography 1 and 7 days after 17 surgeries. The follow-up period ranged from 12 to 37 months (24.9 in average).Results The outcome of 17 surgeries was excellent (disappearance of transient ischemic attack) in 14 hemispheres (82.4%) and good (reduction of transient ischemic attack) in three hemispheres (17.6%). No patient suffered peri-operative infarction, except for one (5.9%) manifesting as pseudolaminar necrosis in a part of the cerebral cortex supplied by STA-MCA bypass at the subacute stage, which did not affect his long-term neurological status. One patient (5.9%) presented with transient facial palsy due to hyperperfusion, which resolved within several days. No patient manifested permanent neurological deterioration during the follow-up period.Conclusion The STA-MCA anastomosis is a safe and effective treatment for childhood moyamoya disease. We recommend routine CBF measurement for avoiding surgical complications including both cerebral ischemia and hyperperfusion.