颞浅动脉-大脑中动脉吻合术结合脑-硬脑膜-肌肉血管融合术治疗烟雾病  

Superficial temporal artery-middle cerebral artery anastomosis combining with encephaloduromyosynangiosis:for treatment of moyamoya disease

作　　者：徐斌[1] 宋冬雷[1] 毛颖[1] 徐宏[2] 顾宇翔[1] 陈功[1] 田彦龙[1] 廖煜君[1] 杨晨[1] 周良辅[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200040 [2]常熟市第一人民医院神经外科

出　　处：《中国脑血管病杂志》2007年第10期445-448,共4页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的：探讨颞浅动脉-大脑中动脉吻合结合脑-硬膜-肌肉血管融合术治疗烟雾病的临床疗效。方法：选择27例烟雾病患者。采用Matsushima（1990）的分型标准,27例患者中6例为第3期,11例为第4期,7例为第5期,3例为第6期;以缺血首发21例,出血首发6例。27例均行颞浅动脉-大脑中动脉分支吻合与脑-硬脑膜-肌肉血管融合术相结合的手术治疗,其中3例行同侧颞浅动脉2个分支吻合,1例行双侧手术。术中采用多普勒超声,术后采用CTA、DSA观察吻合血管通畅情况,并采用TCD、CT灌注评价脑血流改善情况。结果：①吻合口通畅情况：27例患者吻合口全部通畅。7例DSA复查显示,与间接手术相关的脑膜动脉和颞中深动脉均与皮质动脉之间形成新生血管吻合。②脑血流改善情况：26例术后1周内复查CT灌注成像,显示吻合侧血流量、血容量及血流峰值时间明显优于对侧。③临床症状改善情况：缺血患者术后TIA未再发作,原有缺血症状改善或消失;6例出血患者随访至今,未再有出血。④并发症：1例Ⅳ型患者术后第3天CT复查显示,距吻合口约3～4cm的前方左侧额叶出现新发小片梗死灶。全部患者未出现由于破坏原有自发血管吻合、颞肌占位效应及过度灌注等并发症。结论：颞浅动脉-大脑中动脉分支直接吻合术结合脑-硬脑膜-肌肉血管融合术对脑烟雾病患者具有较好的疗效。Objective To evaluate the therapeutic effect of superficial temporal artery - middle cerebral artery [ STA - MCA ] anastomosis combining with encephaloduromyosynangiosis in treatment of moyamoya disease. Methods Thirty-one procedures of direct STA - MCA bypass combined with encephaleduromyosynangiosis were performed on 22 hemispheres in 21 cases of ischemic - type and 6 cases of hemorrhagic - type moyamoya disease. According to Suzuki g （1969） criterion, 6 cases were in stage 3, 11 cases in stage 4, 7 cases in stage 5, and 3 cases in stage 6. The patency of the anastomosis was verified using intraoperative ultrasonic Doppler and CTA after operation. The change of the brain blood flow was assessed using CTP or TCD within 1 week. DSA was need for followed up study after 4 ～ 6 months. Results All the 31 direct anastomoses were patent. The cerebral blood flow in the effected regions increased immediately after operation. The ischemic symptoms were relieved in all the patients. No rebleeding was found on follow up. Spontaneous revascularization from the deep temporal artery and the middle meningeal artery was found in all 7 DSA followed up cases. Only 1 case had a complication of small infarction near the anastomosis. Conclusions We named indirect revascularization using temporal muscle （the deep temporal artery） and the dura mater （the middle meningeal artery） as＂ encephaloduromyosynangiosis （EDMS）＂. The combination of STA - MCA bypass with EDMS is a new rational cerebral revascularization in treatment of moyamoya disease.

关 键 词：脑底异常血管网病 脑血管重建术 

分 类 号：R651.1[医药卫生—外科学]