Objective

We evaluated what few studies emphasized the postoperative collateral formation and cerebral hemodynamics of hemorrhagic moyamoya disease (MMD).

Methods

Hemorrhagic MMD patients treated surgically were retrospectively collected and dichotomized into combined bypass (CB) and indirect bypass (IB) groups. CB used superficial temporal artery-to-middle cerebral artery anastomosis combined with encephaloduroarteriomyosynangiosis (STA-MCA+EDAMS), and IB used encephaloduroarteriomyosynangiosis (EDAMS) for revascularization. Postoperative complications and clinical prognosis, as well as pre- and post-operative Modified Rankin Scale (mRS), collateral circulation status, and cerebral hemodynamics were observed and compared between the CB and IB groups.

Results

A total of 37 patients with hemorrhagic MMD were identified. Of the 68 cerebral hemispheres, 47(69.1%) were combined revascularization, and the rest were indirect. During an average follow-up of 16.5 ± 8.7 months, the recurrent stroke events were significantly lower, as well as having a postoperative mRS scores≤ 2. A satisfactory postoperative collateral formation, and an improved dilation or extension of the anterior choroidal/posterior communication artery (AchA/PcoA) were significantly higher in the CB group than in the IB group (all P < .05). Compared with preoperative cerebral hemodynamics, relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), mean transit time (MTT), and relative time to peak (rTTP) in the CB group; rCBF, rCBV, and MTT in the IB group were significantly improved (all P < .001). The CB group’s postoperative rCBF was significantly improved compared with the IB group (P < .001).

Conclusions

STA-MCA bypass combined with EDAMS can obtain better postoperative collateral formation, cerebral hemodynamics, and clinical prognosis than EDAMS alone.

中文翻译：

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出血性烟雾病联合和间接搭桥血运重建术的术后新生血管、脑血流动力学和临床预后

客观的

我们评估了很少有研究强调出血性烟雾病 (MMD) 的术后侧支形成和脑血流动力学。

方法

回顾性收集接受手术治疗的出血性 MMD 患者，并将其分为联合旁路 (CB) 和间接旁路 (IB) 组。CB采用颞浅动脉-大脑中动脉吻合术联合脑硬膜动脉肌合成管（STA-MCA+EDAMS），IB采用脑硬膜动脉肌合成管（EDAMS）进行血运重建。观察并比较CB组和IB组的术后并发症和临床预后，以及术前和术后改良Rankin量表（mRS）、侧支循环状态和脑血流动力学情况。

结果

共确定了 37 名出血性 MMD 患者。68个大脑半球中，47个（69.1%）联合血运重建，其余为间接血运重建。在平均 16.5 ± 8.7 个月的随访期间，复发性卒中事件显着降低，并且术后 mRS 评分≤2。术后侧支循环良好，前脉络膜/后部交通的扩张或延伸得到改善CB 组的动脉（AchA/PcoA）显着高于 IB 组（均 P < .05）。CB组与术前脑血流动力学、相对脑血流量（rCBF）、相对脑血容量（rCBV）、平均通过时间（MTT）、相对达峰时间（rTTP）比较；IB 组的 rCBF、rCBV 和 MTT 显着改善（均 P < .001）。

结论

STA-MCA旁路联合EDAMS比单独EDAMS可获得更好的术后侧支形成、脑血流动力学和临床预后。