颅骨钻孔硬膜翻转并颞肌骨膜贴敷术治疗成人缺血型烟雾病  

Therapeutic effect of burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis for ischemic moyamoya disease of adults

作　　者：孙中正[1] 谭守刚[2] 王志刚 王成伟[1] 顿志平[1] 丁璇[1] 魏艳[1] 臧贻征[1] Sun Zhongzheng;Tan Shougang;Wang Zhigang;Wang Chengwei;Dun Zhiping;Ding Xuan;Wei Yan;Zang Yizheng(The Second Hospital of Shandong University,Jinan 250033,China)

机构地区：[1]山东大学第二医院神经外科,济南250033 [2]山东省青岛市市立医院神经外科 [3]山东大学齐鲁医院青岛院区神经外科

出　　处：《中华医学杂志》2018年第31期2481-2484,共4页National Medical Journal of China

基　　金：山东省自然基金青年基金（ZR2018QH003）;山东大学第二医院青年基金（Y2015010021）

摘　　要：目的探讨颅骨钻孔硬膜翻转并颞肌骨膜贴敷术治疗成人缺血型烟雾病的临床疗效。方法2013年1月至2018年1月山东大学第二医院神经外科对21例成人缺血型烟雾病患者行颅骨钻孔硬膜翻转并颞肌骨膜贴敷间接血流重建手术。术后随访3个月～3年，行颅脑数字减影血管造影（DSA）复查，并行颅脑MR灌注成像定量观察手术前后脑缺血区血流灌注改善情况，并对手术前后患者卡氏（KPS）评分行统计学分析。结果21例患者术前原有症状术后均有不同程度改善，手术前后KPS评分差异有统计学意义（P〈0.001）。19例患者术后复查颅脑DSA及MR灌注成像，显示总共72个骨孔中有65个骨孔新生血管长入，主要来自脑膜中动脉及颞浅动脉，35个骨孔术中蛛网膜未打开，其中33个有新生血管长入，差异无统计学意义（P〉0.05）。颅脑MR灌注成像定量显示，共复查31侧大脑半球有29侧脑缺血区血流灌注改善。手术并发症包括硬膜下出血1例，短暂性神经功能障碍3例。结论颅骨钻孔硬膜翻转并颞肌骨膜贴敷术治疗成人缺血型烟雾病疗效确切；MR灌注成像能有效评估手术效果；术中蛛网膜打开与否不影响新生血管长入。ObjectiveTo explore the therapeutic effect of burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis for ischemic moyamoya disease of adults.MethodsThe burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis was performed on 21 adults with ischemic moyamoya disease since January 2013 in the second hospital of Shandong university.All of the patients were followed up for 3 months to 3 years.Digital subtraction angiogram （DSA） reexamination was performed and the cerebral MR perfusion imaging （PWI） was used to observe the perfusion of cerebral ischemic area before and after operation quantificationally, and the KPS scores before and after the surgery were analysed by the statistics.The clinical symptoms of the 21 patients gradually improved after the operation, there was statistical significance by paired t test of the KPS scores （P〈0.001）.Results19 patients were reexamined by DSA and PWI.The DSA results revealed there was apparent neovascularization in 65 burr-holes of total 72 holes , mainly came from the middle meningeal artery and superficial artery, and there was neovascularization in 33 burr-holes of total 35 holes whose arachnoid was completed, there was no statistical significance by χ^2 test （P〉0.05）. The revascularization of the ischemic cerebral tissue was obtained through the PWI.The postoperative complications included 1 case of subdural hematoma, 3 cases of postoperative temporary neurological deficits.ConclusionThe burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis was effective, the MR perfusion imaging could assessment the effect exactly, there was no significant difference of neovascularization whether or not opening the arachnoid.

关 键 词：烟雾病 颅骨钻孔 硬膜翻转 蛛网膜 磁共振灌注 

分 类 号：R651.12[医药卫生—外科学]