颅内外动脉搭桥和颞肌贴覆术治疗烟雾综合征的临床分析
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摘要
目的:探讨颞浅动脉-大脑中动脉搭桥和脑颞肌贴覆术治疗烟雾综合征的临床效果和影响因素。方法:选取普洱市人民医院2014年至2018年烟雾综合征患者22例,同时影像学提示均合并有脑梗塞病灶,症状表现为不同程度的头晕,肢体功能障碍。经DSA(数字减影血管造影)确诊存在烟雾血管,在发病7～14 d内行手术治疗,其中9例行颞浅动脉-大脑中动脉搭桥同时行颞肌贴覆术,13例单纯行颞肌贴覆和硬脑膜血管翻转术。结果:术后6个月回访所有患者脑缺血症状均有所改善,15例肌力和肢体活动较术前明显好转。DSA检查提示18例患者病变区血管明显增生,颈外动脉造影可见病变区有明显颈外动脉供血。结论:颞浅动脉-大脑中动脉搭桥和颞肌贴覆术治疗烟雾综合征合并脑梗塞患者安全有效。
Objective: To explore the clinical effects and influencing factors of superficial temporal arterial-middle cerebral artery bypass and cerebral temporal muscle attachment in the treatment of moyamoya syndrome. Methods: 22 patients with moyamoya syndrome in People's Hospital of Pu'er City from 2014 to 2018 were selected. Meanwhile, imaging indications showed that all patients had cerebral infarction lesions, and the symptoms were varying degrees of dizziness and limb decline. By DSA, the patients were diagnosed with obvious moyamoya vessels, and underwent surgeries in 7 to 14 days. Among them, 9 cases had superficial temporal artery-middle cerebral artery bypass and temporal muscle attachment, 13 cases were treated by temporal muscle attachment and dural vascular inversion. Results: 6 months after the surgeries, all patients' ischemic symptoms improved obviously. Muscle strength and limb movement were significantly improved in 15 cases. DSA demonstrated vascular hyperplasia was obvious in the lesion area in 18 patients,and external carotid arteriography showed obvious external carotid artery blood supply in the lesion area. Conclusion: Superficial temporal artery-middle cerebral artery bypass and temporal muscle attachment are safe and effective in the treatment of patients with moyamoya syndrome and cerebral infarction.
Objective: To explore the clinical effects and influencing factors of superficial temporal arterial-middle cerebral artery bypass and cerebral temporal muscle attachment in the treatment of moyamoya syndrome. Methods: 22 patients with moyamoya syndrome in People's Hospital of Pu'er City from 2014 to 2018 were selected. Meanwhile, imaging indications showed that all patients had cerebral infarction lesions, and the symptoms were varying degrees of dizziness and limb decline. By DSA, the patients were diagnosed with obvious moyamoya vessels, and underwent surgeries in 7 to 14 days. Among them, 9 cases had superficial temporal artery-middle cerebral artery bypass and temporal muscle attachment, 13 cases were treated by temporal muscle attachment and dural vascular inversion. Results: 6 months after the surgeries, all patients' ischemic symptoms improved obviously. Muscle strength and limb movement were significantly improved in 15 cases. DSA demonstrated vascular hyperplasia was obvious in the lesion area in 18 patients,and external carotid arteriography showed obvious external carotid artery blood supply in the lesion area. Conclusion: Superficial temporal artery-middle cerebral artery bypass and temporal muscle attachment are safe and effective in the treatment of patients with moyamoya syndrome and cerebral infarction.
引文
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[2]CHEN Z,ZHANG L,QU J,et al.Clinical analysis of combined revascularization in treating ischemic Moyamoya disease in adults[J].Neurochirurgie,2018,64(1):49-52.
[3]LOW S W,TEO K,LWIN S,et al.Improvement in cerebral hemodynamic parameters and outcomes after superficial temporal artery-middle cerebral artery bypass in patients with severe stenoocclusive disease of the intracranial internal carotid or middle cerebral arteries[J].J Neurosurg,2015,123(3):662-669.
[4]HWANG G,OH C W,BANG J S,et al.Superficial temporal artery to middle cerebral artery bypass in acute ischemic stroke and stroke in progress[J].Neurosurgery,2011,68(3):723-729.
[5]SUZUKI Y,NEGORO M,SHIBUYA M,et al.Surgical treatment for pediatric moyamoya disease:use of the superficial temporal artery for both areas supplied by the anterior and middle cerebral arteries[J].Neurosurgery,1997,40(2):324-329.
[6]INOUE A,KOHNO K,IWATA S,et al.Efficacy of early superficial temporal artery-middle cerebral artery double anastomoses for atherosclerotic occlusion in patients with progressing stroke[J].J Stroke Cerebrovasc Dis,2017,26(4):741-748.
[7]OKU T,NOGAMI K,KOIZUMI H,et al.External carotid artery stenting and superficial temporal artery to middle cerebral artery anastomosis for internal carotid artery occlusionwithexternalcarotidarteryseverestenosis:casereport[J].Neurol Med Chir(Tokyo),2012,52(12):906-909.
[8]GRUBB R L JR,POWERS W J,CLARKE W R,et al.Surgical results of the carotid occlusion surgery study[J].JNeurosurg,2013,118(1):25-33.