Therapeutic Effect Of The Extracranial-Intracranial Bypass For Adult Moyamoya Disease

Objective: To explore the clinical efficacy of Intracranial and Extracranial vascular reconstruction in the treatment of adult moyamoya disease,so as to provide a reasonable basis for clinical treatment.Methods:Clinical data of 22 patients with moyamoya disease who were treated with Intracranial and Extracranial vascular reconstruction and diagnosed with moyamoya disease by whole brain angiography(DSA)before the operation,also the characteristics of the cases were confirmed by CT and CT perfusion imaging(CTP).CTP and DSA were reviewed 6 months after surgery to evaluate the postoperative hemodynamic changes and collateral circulation.All patients were evaluated for clinical symptoms and life ability according to Trapathi clinical symptom evaluation criteria and modified daily living ability scale(MBI)before and 6 months after surgery.The clinical symptoms,quality of life,hemodynamics and collateral circulation of the patients before and after surgery were compared,so as to evaluate the therapeutic effect of intracranial and Extracranial vascular reconstruction for adult patients with moyamoya disease.Results:1.According to the clinical symptom evaluation criteria of Trapathi,the clinical symptoms of the patients were evaluated preoperative and 6 months after surgery.The clinical symptoms were improved as excellent in 6 cases and good in 10 cases,which were regarded as effective.The clinical symptoms were effectively improved in 16 patients,with an improvement rate of 72.72%.2.The Wilcoxon symbolic rank sum test was used for statistical analysis by combining the preoperative and postoperative modified daily living ability scale scores of all the patients,and the difference was statistically significant(P < 0.05).3.CT perfusion parameters related to rCBF and rCBV were significantly increased and rMTT significantly decreased 6 months after surgery compared with that before surgery.Paired test was used for statistical analysis,and the difference before and after surgery was statistically significant(P < 0.05).4.Whole brain angiography was performed postoperative in all patients,with 12 cases of excellent neonatal collateral circulation and 7 cases of good neonatal collateral circulation.Excellent and good neonatal collateral circulation were regarded as effective,with a total effective rate of 86.36%.Conclusion:1.Intracranial and Extracranial vascular reconstruction can effectively improve the clinical symptoms of adult patients with moyamoya disease and improve the quality of life.2.Intracranial and Extracranial vascular reconstruction can effectively promote the formation of compensatory collateral circulation in adult patients with moyamoya disease,improve local hemodynamics,increase cerebral blood perfusion,and improve brain function.