Surgical Outcomes for Moyamoya Angiopathy at Barrow Neurological Institute With Comparison of Adult Indirect Encephaloduroarteriosynangiosis Bypass, Adult Direct Superficial Temporal Artery–to–Middle Cerebral Artery Bypass, and Pediatric Bypass

医学 改良兰金量表 颞浅动脉 烟雾病 大脑中动脉 外科 搭桥手术 血运重建 冲程(发动机) 麻醉 动脉 心脏病学 缺血性中风 缺血 心肌梗塞 工程类 机械工程
作者
Adib A. Abla,Gurpreet S. Gandhoke,Justin C. Clark,Mark E. Oppenlander,Gregory J. Velat,Joseph M. Zabramski,Felipe C. Albuquerque,Peter Nakaji,Robert F. Spetzler,John E. Wanebo
出处
期刊:Neurosurgery [Lippincott Williams & Wilkins]
卷期号:73 (3): 430-439 被引量:91
标识
DOI:10.1227/neu.0000000000000017
摘要

BACKGROUND: Untreated, moyamoya angiopathy is a progressive vaso-occlusive process that can lead to ischemic or hemorrhagic stroke. OBJECTIVE: To review 1 institution's surgical experience with both direct and indirect bypass (encephaloduroarteriosynangiosis) in adult and pediatric groups. METHODS: A retrospective review was conducted of a consecutive series of patients treated for moyamoya angiopathy between 1995 and 2009. RESULTS: Thirty-nine adult patients underwent indirect bypass as their initial therapy; 29 adult patients underwent direct bypass. Twenty-four pediatric patients included 20 indirect bypasses and 4 direct bypasses. Overall, 140 hemispheres were treated; 48 patients received revascularization of both hemispheres. There were 14 additional revascularization procedures (10% per hemisphere) performed over a site of continued hypoperfusion postoperatively. Fourteen postoperative ischemic strokes occurred during the entire follow-up (10% per hemisphere), and the Kaplan-Meier analysis was not significantly different between groups (P = .59). Four grafts (9.09%) had failed at radiographic follow-up of the 44 direct bypasses performed. Before the initial surgery, the modified Rankin Scale score was 1.58 ± 0.93, 1.48 ± 0.74, and 1.8 ± 1.1 in the pediatric, adult direct, and adult indirect groups (P = .39). At last follow-up, it was 1.29 ± 1.31, 1.09 ± 0.90, and 1.94 ± 1.51 (P = .04) in the pediatric, adult direct, and adult indirect groups. CONCLUSION: This series demonstrates that both direct and indirect bypasses can be equally effective in preventing stroke. However, in adult patients, direct bypass patients had significantly greater improvement in symptoms, as seen in modified Rankin Scale scores. Pediatric patients, despite undergoing predominantly indirect bypasses, fared roughly the same as the adults in the direct bypass group. ABBREVIATIONS: CTA, computed tomographic angiography CTP, computed tomographic perfusion imaging EDAS, encephaloduroarteriosynangiosis MCA, middle cerebral artery mRS, modified Rankin Scale STA, superficial temporal artery
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