儿童单侧出血型烟雾病脑血运重建术的中长期疗效及预后分析  

Analysis of the medium-and long-term curative effects and prognosis of cerebrovascular revascularization for children with unilateral hemorrhagic moyamoya disease

作　　者：朱宸宇 李文杰 朱桓 张启航 刘通 杨桐宇 张岩 刘兴炬[1,2] ZHU Chenyu;LI Wenjie;ZHU Huan;ZHANG Qihang;LIU Tong;YANG Tongyu;ZHANG Yan;LIU Xingju(Department of Neurosurgery,Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China)

机构地区：[1]北京市神经外科研究所,北京100070 [2]首都医科大学附属北京天坛医院神经外科学中心

出　　处：《临床神经外科杂志》2025年第2期121-125,共5页Journal of Clinical Neurosurgery

基　　金：国家自然科学基金面上项目(82371915)。

摘　　要：目的 探讨儿童单侧出血型烟雾病(MMD)脑血运重建术后的中长期疗效。方法 回顾性分析2010年10月—2025年2月北京天坛医院收治的13例单侧出血型MMD患儿的临床资料,其中11例接受颞浅动脉-大脑中动脉(STA-MCA)吻合联合脑硬膜动脉血管融通术(EDAS),1例行单纯EDAS术,1例接受保守治疗。随访主要事件包括再发脑出血、脑梗死、死亡。结果 13例患儿中,脑室出血5例(38.5%),中位随访时间93(51,133)个月,1例(7.7%)在EDAS术后29个月时出现再出血,1例(7.7%)联合脑血运重建术后2个月时出现短暂性脑缺血发作(TIA),在7个月时出现新发脑梗死,无死亡病例,11例(84.6%)患者神经功能良好(mRS≤2);随访期间复查CTA未观察到对侧进展病例。结论 单侧儿童出血MMD中长期正常侧血管闭塞进展风险较低,联合脑血运重建术可有效降低儿童单侧出血型MMD的中长期再出血风险。Objective To explore the medium-and long-term curative effects after cerebrovascular revascularization for children with unilateral hemorrhagic moyamoya disease(MMD).Methods The clinical data of 13 pediatric patients with unilateral hemorrhagic MMD who underwent treatment at Beijing Tiantan Hospital from October 2010 to February 2025 were analyzed retrospectively.Among them,11 received combined superficial temporal artery-middle cerebral artery(STA-MCA) bypass with encephalo-duro-arterio-synangiosis(EDAS),1 underwent EDAS alone,and 1 was treated conservatively.Follow-up endpoints included rebleeding,cerebral infarction,and death.Results Among 13 children,intraventricular hemorrhage predominated in 4 cases(38.5%).During a median follow-up of 93 months(IQR 51-133),rebleeding occurred in 1 patient(7.7%) at 29 months post-EDAS surgery.Additionally,1 patient(7.7%) experienced a transient ischemic attack(TIA) 2 months after combined revascularization,followed by a new cerebral infarction at 7 months postoperatively.No mortality or contralateral progression was observed on follow-up computed tomography angiography(CTA).Favorable neurological outcomes(modified Rankin Scale score ≤2) were achieved in 84.6%(11/13) of cases.Conclusions Unilateral hemorrhagic MMD in pediatric patients shows a low risk of contralateral progression during medium-and long-term follow-up.Combined cerebral revascularization effectively mitigates rebleeding risk and ensures favorable neurological outcomes,highlighting its safety and efficacy in pediatric populations.

关 键 词：烟雾病 脑血运重建术 儿童 神经功能预后 随访研究 

分 类 号：R743[医药卫生—神经病学与精神病学] R651[医药卫生—临床医学]