Effective Surgical Revascularization Improves Cerebral Hemodynamics and Resolves Headache in Pediatric Moyamoya Disease
Effective Surgical Revascularization Improves Cerebral Hemodynamics and Resolves Headache in Pediatric Moyamoya Disease
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DOI：
10.1016/j.wneu.2012.08.005
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发表时间：
2013-11-01
影响因子：
2
通讯作者：
Tamaki, Nagara
中科院分区：
文献类型：
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作者：
Kawabori, Masahito;Kuroda, Satoshi;Tamaki, Nagara
背景：头痛是儿童烟雾病的主要临床表现之一。然而，其临床特征和潜在机制尚未完全了解。本研究旨在阐明儿童Moyamoya病头痛的临床特点和手术血运重建的效果。方法：本研究包括29例儿童Moyamoya病患者，接受颞浅动脉-大脑中动脉（STA-MCA）吻合术和间接转流术。他们的医疗记录被精确评估，以确定他们头痛的临床特征。磁共振成像，正电子发射断层扫描，单光子发射计算机断层扫描的结果也进行了analysed.Results：术前头痛记录在11（38%）的29例。大部分患者主诉早晨出现额部或颞部剧烈头痛。头痛与更晚期的疾病阶段和脑血流量的减少及其对乙酰唑胺的反应性显著相关。手术血运重建完全解决头痛在所有11 patients.CONCLUSIONS：这些研究结果强烈表明，脑血流动力学紊乱可能发挥关键作用，在儿童烟雾病严重头痛。STA-MCA吻合术和脑-硬脑膜-肌-动脉-颅周血管结合术可能是通过向手术侧半球广泛供应侧支血流而迅速解决头痛的有效方法。
BACKGROUND: Headache is one of the major clinical presentations in pediatric Moyamoya disease. However, the clinical features and underlying mechanisms are not fully understood. This study aimed to clarify the clinical feature of headache in pediatric Moyamoya disease and the effect of surgical revascularization.METHODS: This study included 29 pediatric patients who underwent superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and indirect bypass for Moyamoya disease. Their medical records were precisely evaluated to identify the clinical features of their headache. The findings on magnetic resonance imaging, positron emission tomography, and single-photon emission computed tomography also were analyzed.RESULTS: Preoperative headache was documented in 11 (38%) of 29 patients. The majority of them complained of severe headache in the frontal or temporal region in the morning. Headache was significantly related to more advanced disease stage and to the decreases in cerebral blood flow and its reactivity to acetazolamide. Surgical revascularization completely resolved headache in all 11 patients.CONCLUSIONS: These findings strongly suggest that disturbed cerebral hemodynamics may play key roles in developing severe headache in pediatric Moyamoya disease. STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis may be effective procedures to rapidly resolve headache by widely supplying collateral blood flow to the operated hemispheres.