颅外-颅内联合脑血运重建术治疗出血型烟雾病的远期临床预后及脑灌注状态研究  

Research of long-term clinical prognosis and cerebral perfusion of hemorrhagic Moyamoya disease after combined extra-intracranial bypass

作　　者：陈浩[1] 王毅[2] 吴凌云 石志勇 杨咏波[2] Chen Hao;Wang Yi;Wu Lingyun;Shi Zhiyong;Yang Yongbo(Department of Neurosurgery,Nanjing Drum Tower Hospital Clinical College of Jiangsu University,Nanjing 210008,China;不详)

机构地区：[1]江苏大学鼓楼临床医学院神经外科,南京210008 [2]南京鼓楼医院神经外科

出　　处：《中国脑血管病杂志》2023年第9期587-596,共10页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金青年项目(82201481)。

摘　　要：目的 研究颅外-颅内联合脑血运重建术对出血型烟雾病的远期作用。方法 回顾性连续纳入2018年1月至2019年1月就诊于南京鼓楼医院神经外科行颞浅动脉-大脑中动脉旁路移植术+脑硬膜动脉贴敷术的成人出血型烟雾病患者。收集患者的一般资料及临床资料,包括性别、年龄、高血压病史、糖尿病史、吸烟史、出血位置(蛛网膜下腔、单纯脑室、脑实质)、出血半球、术前是否反复出血、改良Rankin量表(mRS)评分、头部CT灌注(CTP)检查数据及DSA资料等。术后近期(3~6个月)随访时收集MR血管成像(MRA)资料,评价旁路移植血管通畅性;新近一次远期(术后>12个月)随访时收集是否存在新发卒中事件(短暂性脑缺血发作、脑梗死、脑出血等)、mRS评分、头部CTP数据及DSA资料等。通过头部DSA评价手术侧半球改良铃木分期,铃木分期Ⅰ、Ⅱ期为早期,Ⅲ、Ⅳ期为中期,Ⅴ、Ⅵ期为晚期。根据手术侧的大脑半球DSA对烟雾血管浓集程度分级,大脑半球底部未见烟雾血管定义为无,虽在脑底形成了烟雾血管,但比较稀疏定义为稀疏,脑底部可见大量的烟雾血管在颈内动脉末端吻合,形成烟雾网络,并在脑底向各个方向扩展定义为浓集。通过远期随访头部DSA评价旁路移植血管通畅性,并与术后近期随访MRA比较,若旁路移植血管显影纤细或不显影,则定义为纤细或萎缩,若旁路移植血管显影扩张或形态不变,则定义为扩张或不变。基于大脑中动脉(侧位)的DSA,使用松岛分级评价新生代偿血管,以颈外动脉造影的新生血管分布范围占大脑中动脉分布区域比例进行分级,A级为>2/3,B级为1/3~2/3,C级为<1/3。与术前相比,若远期随访时mRS评分降低,则定义为神经功能预后改善,评分不变定义为神经功能无变化,评分增加定义为神经功能恶化;神经功能结局以mRS评分为评价标准,0~1分为无残疾,2~3分为轻度至中度残疾,4~5分Objective To investigate the long-term effects of combined extracranial-intracranial bypass on hemorrhagic Moyamoya disease(hMMD).Methods Adults with hMMD treated by superficial temporal artery-middle cerebral artery bypass and encephalo-duro-synangiosis(EDAS)who admitted to the Department of Neurosurgery,Nanjing Drum Tower Hospital from January 2018 to January 2019 were retrospectively reviewed.General and clinical data of the hMMD patients were collected,including gender,age,history of hypertension,history of diabetes mellitus,history of smoking,location of hemorrhage(subarachnoid space,simple ventricle,brain parenchyma),hemisphere of bleeding,history of recurrent hemorrhage,modified Rankin Scale(mRS)scores,hemispheric data of CTP examination,and DSA.MR angiography(MRA)was collected at short-term follow-up(3-6 months after bypass)to evaluate patency of direct bypass graft.Moreover,data of long-term follow-up(LTFU),characterized by over 12 months after bypass,were also collected including presence of new-onset of stroke events(transient ischemic attack,cerebral infarction,cerebral hemorrhage,etc.),mRS scores,hemispheric CTP data,and DSA data.The modified Suzuki stage of the ipsilateral hemisphere was evaluated by DSA,in which Suzuki stagesⅠandⅡwere considered as early stage,Suzuki stagesⅢandⅣas middle stage,and Suzuki stagesⅤandⅥas advanced stage.The degree of Moyamoya vessel concentration was graded according to the DSA of the ipsilateral hemisphere.The absence of Moyamoya vessels at the base of the cerebral hemisphere was defined as absent.Although Moyamoya vessels were formed at the base of the brain,they were sparse and defined as sparse.The dense Moyamoya vessels was defined as a large number of smoke vessels formed at the base of the brain anastomosing at the end of the internal carotid artery to form a network of Moyamoya vessels,which was extended in all directions at the base of the brain.Compared with short-term follow-up of MRA,bypass patency was evaluated by follow-up cerebral DSA which w

关 键 词：脑底异常血管网病 预后 脑血管循环 联合血运重建术 颞浅动脉-大脑中动脉旁路移植术 

分 类 号：R651.12[医药卫生—外科学]