Efficacy and Safety of Combined Revascularization Surgery for Moyamoya Disease: Standard Procedure and Perioperative Management.

Q2 Medicine

Acta neurochirurgica. Supplement Pub Date : 2025-01-01 DOI:10.1007/978-3-031-89844-0_12

Miki Fujimura, Masaki Ito, Haruto Uchino, Masahito Kawabori, Taku Sugiyama

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引用次数: 0

Abstract

Objective: Revascularization surgery such as superficial temporal artery-middle cerebral artery (STA-MCA) bypass is a standard management choice for symptomatic moyamoya disease (MMD) patients, with either ischemic or hemorrhagic presentation. We sought to clarify the efficacy and safety of institutional standardized revascularization procedures for MMD.

Materials and methods: The present study includes 37 consecutive patients with MMD (2-60 years old, 42.0 on average) undergoing revascularization surgery on 42 affected hemispheres. Direct-indirect combined revascularization surgery was performed on most hemispheres (41/42, 97.6%), including STA-MCA bypass (39 hemispheres) and occipital artery-posterior cerebral artery bypass (2 hemispheres). All patients underwent standardized perioperative management with strict blood pressure control (110-130 mmHg) based on routine single-photon emission computed tomography (SPECT) 1 and 7 days after surgery. Then we investigated the outcome of surgeries, focusing mainly on that of combined revascularization procedures.

Results: The outcome of 42 surgeries was favorable in all cases, except for one adult (2.3%) manifesting with cerebral hyperperfusion syndrome leading to neurological worsening. None of the patients developed perioperative cerebral infarction (0/42; 0%), and the patency of the direct bypass was confirmed via MRA in all patients undergoing combined procedure (41/41, 100%). Two patients suffered wound-healing delay, one of which required resuture.

Conclusion: The combined revascularization surgery is a safe and effective treatment for MMD, while local cerebral hyperperfusion is a potential complication that should be avoided through intensive perioperative care.

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烟雾病联合血运重建术的疗效和安全性：标准程序和围手术期管理。

目的：血管重建术，如颞浅动脉-大脑中动脉（STA-MCA）旁路手术是有缺血性或出血症状的烟雾病（MMD）患者的标准治疗选择。我们试图阐明针对烟雾病的制度性标准化血运重建程序的有效性和安全性。材料和方法：本研究包括37例连续的MMD患者（2-60岁，平均42.0岁），对42个受累半球进行血管重建术。大多数半脑行直接-间接联合血运重建术（41/42,97.6%），包括STA-MCA搭桥术（39个半脑）和枕动脉-大脑后动脉搭桥术（2个半脑）。所有患者术后1天和7天通过常规单光子发射计算机断层扫描（SPECT）严格控制血压（110-130 mmHg），接受标准化围手术期管理。然后我们调查了手术的结果，主要关注联合血运重建术的结果。结果：42例手术除1例成人（2.3%）表现为脑高灌注综合征导致神经系统恶化外，所有病例预后良好。无患者发生围手术期脑梗死(0/42；0%)，所有接受联合手术的患者均通过MRA确认直接旁路通畅（41/ 41,100 %）。2例患者出现伤口愈合延迟，其中1例需要重新缝合。结论：联合血运重建术是一种安全有效的治疗烟雾病的方法，而局部脑过度灌注是一种潜在的并发症，应通过围手术期的强化护理来避免。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta neurochirurgica. Supplement Medicine-Surgery

CiteScore

1.90

自引率

0.00%

发文量

期刊介绍： In addition to the regular journal, "Acta Neurochirurgica" publishes 3-4 supplement volumes per year. These comprise proceedings of international meetings or other material of general neurosurgical interest.