摘要
目的探讨动脉粥样硬化性烟雾综合征的临床特征和手术疗效。方法回顾性分析21例动脉粥样硬化性烟雾综合征病人的临床资料,对比手术前后mRS评分、卒中发生率及症状改善等情况,判断手术疗效。结果所有病人术中荧光造影提示搭桥血管通畅性良好。术后搭桥血管闭塞1例,脑梗死3例,脑过度灌注1例,伤口浅表部位感染1例,均给予对症处理。影像学随访3~14个月,13例行MRA或CTA检查,搭桥血管通畅性良好6例,不通畅7例。10例行CT灌注(CTperfusion,CTP)或MRI动脉自旋标记灌注技术(arterialspinlabeling,ASL)检查,大脑灌注改善7例,无明显改善3例。临床随访7~52个月,病人mRS评分降低13例,无变化6例,升高2例;随访期间未发生缺血性或出血性卒中等严重不良事件,无死亡病例。结论有吸烟史、合并高血压且超重的中老年人群应警惕动脉粥样硬化性烟雾综合征的发生。颅内外搭桥手术可以显著改善病人预后,降低卒中发生率。
Objective To investigate the clinical characteristics and surgical outcomes in patients with atherosclerotic Moyamoya syndrome(AMS).Methods Clinical data of 21 patients with AMS were analyzed retrospectively.The modified Rankin scale(mRS)score,stroke rate and the improvement of symptoms were compared between the preoperation and postoperation to evaluate the therapeutic effect of the operation.Results Intraoperative fluorescein angiography demonstrated good patency of the bridging vessels in all the patients.Bridging vessel occlusion occurred in 1 patient,cerebral infarction in 3,cerebral hyperperfusion in 1 and wound infection in 1 after the operation,and all were treated with symptomatic treatment.During an imaging follow-up period of 3 to 14 months,MRA or CTA examination was performed in 13 patients,bridging vessel patency was achieved in 6 and occlusion in 7.CT perfusion(CTP)or arterial spin labeling(ASL)examination was performed in 10 patients,cerebral blood perfusion was improved in 7 and not obviously improved in 3.During a clinical follow-up period of 7 to 52 months,the mRS scores reduced in 13 patients,not changed in 6 and increased in 2.No serious events such as ischemic or hemorrhagic stroke occurred and no patient died during the follow-up period.Conclusions The middle-aged people with smoking history,hypertension and overweight should be on guard against the occurrence of AMS.Extracranial and intracranial bypass surgery can significantly improve the prognosis of patients and reduce the incidence of stroke.
作者
向鑫
雷霆
钱海
胡孟庆
王瑾
贾倩
陈秀娥
刘方军
Xiang Xin;Lei Ting;Qian Hai;Hu Mengqing;Wang Jin;Jia Qian;Chen Xiu'e;Liu Fangjun(Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University,Beijing 100093,China)
出处
《中国微侵袭神经外科杂志》
CAS
2021年第9期417-420,共4页
Chinese Journal of Minimally Invasive Neurosurgery
