脑血运重建术治疗成人脑底异常血管网病的疗效分析

目的 探讨颞浅动脉（STA）-大脑中动脉（MCA）分流术联合颞肌贴敷术治疗脑底异常血管网病（MMD）时单支血管分流术与双支血管分流术的疗效差异。方法 2020年1月至2022年6月前瞻性收治符合标准的MMD共59例，37例应用STAMCA单支血管分流术联合颞肌贴敷术治疗（单支分流组），22例应用STA-MCA双支血管分流术联合颞肌贴敷术治疗（双支分流组）。结果 术后3个月DSA或CTA显示分流血管通畅，其中分流血管显影良好38例；49例（83.1%）神经功能改善（手术前后mRS评分差值>0）,47例（79.7%）脑组织血供改善（手术前后脑灌注评分差值<0）；未发生手术相关并发症。两组术后3个月m RS评分及脑灌注评分均明显改善（P<0.05），而且，双支血管分流组明显优于单支血管分流组（P<0.05）。双支血管分流组术后mRS评分改善率、脑灌注评分改善率均明显高于单支血管分流组（P<0.05）。结论 STA-MCA分流术联合颞肌贴敷术治疗MMD疗效良好，而且双支血管分流术的短期预后优于单支血管分流术。

Short-term efficacy of STA-MCA bypass combined with ence-phalo-myo-synangiosis for adult moyamoya diseases: single-vessel bypass vs. double-vessel bypass

Objective To analyze the short-term prognosis of superficial temporal artery (STA)-middle cerebral artery (MCA) combined with ence-phalo-myo-synangiosis for patients with moyamoya disease (MMD). Methods A total of 59 patients with MMD were prospectively recruited from January 2020 to June 2022. Thirty-seven patients were treated with STA-MCA single-vessel bypass combined with ence-phalo-myo-synangiosis (single bypass group), and 22 patients were treated with STA-MCA double-vessel bypass combined with ence-phalo-myo-synangiosis (double bypass group). Results Three months after the operation, DSA or CTA showed patency in all bypass vessels. Neurological function was improved ( with a difference of mRS score before and after operation >0) in 49 patients (83.1%), and brain tissue blood supply was improved ( with a difference of cerebral perfusion score before and after surgery <0) in 47 patients (79.7%). There were no surgery-related complications. The mRS and cerebral perfusion scores were significantly improved in both groups 3 months after the surgery (P<0.05), and they were significantly better in the double bypass group than those in the single bypass group (P<0.05). The improvement rates of mRS score and cerebral perfusion score in the double bypass group were significantly higher than those in the single bypass group (P<0.05). Conclusions STA-MCA bypass combined with ence-phalo-myo-synangiosis is effective for treating MMD, and the short-term prognosis of double-vessel bypass is better than that of the single-vessle bypass.