| Objective According to statistics,about 3.4%-14.8% of patients with moyamoya disease are associated with intracranial aneurysms.This subtype has a higher tendency for intracranial hemorrhage and is prone to rebleeding after surgery.How to deal with aneurysms and reduce the risk of rebleeding in patients is a difficult problem to be overcome.This study described the clinical characteristics of moyamoya disease with aneurysms,explored independent risk factors that affect prognosis and rebleeding,and provided a basis for clinical treatment decisions through the discussion of surgical options.Methods A retrospective study of 337 cases of moyamoya disease admitted to the Department of Neurosurgery of The Second Affiliated Hospital of Zhejiang University School of Medicine from March 31,2011 to March 31,2019,286 cases with undiagnosed aneurysms,9 cases with incomplete data,1 case lost to follow-up,and finally 41 eligible patients were included.Describe and analyze its clinical characteristics,and use single-factor and multi-factor analysis to screen independent risk factors that affect patients’ prognosis and rebleeding.Kaplan-Meier method was then used to perform rebleeding survival analysis,log-rank method was used to compare the differences in survival curves between different groups,and meaningful factors were incorporated into the Cox proportional hazard model for rebleeding multivariate analysis to explore the effects of moyamoya disease partners.Independent risk factors for aneurysm rebleeding risk.Finally,the choice of surgical scheme was explored through typical cases.Results Of the 41 patients with moyamoya disease and aneurysm,27 were hemorrhagic and 14 were ischemic.The mean age of onset was 49.1 ± 10.2 years,and the male to female ratio was 0.64:1.The median Glasgow coma index score was 13 points,and the median staging of the mozambique-modified Suzuki stage was 3 stages.Of the 41 patients,30 had aneurysms in the main artery,4 had peripheral arteries,and 7 had multiple aneurysms,of which 13 had aneurysm rupture.Surgical treatment was performed in 31 cases and conservative treatment in 10 cases.Only 15 cases of bypass grafting were performed during surgery,9 cases of bypass graft and aneurysm craniotomy,3 cases of aneurysm craniotomy,3 cases of bypass and aneurysm interventional embolization,and 1 case of aneurysm interventional embolization.Complications occurred in 23 cases,short-term complications in 10 cases,and long-term complications in 18 cases.Of these,12 patients had rebleeding and 6 died.The admission GCS score(P = 0.023)was an independent risk factor for short-term complications.An independent risk factor for patients with long-term neurologic improvement was rebleeding(P = 0.003).Finally,we found that patients with larger smoke-like blood vessel distribution range(OR = 23.703,95CI%(1.413 ~ 397.740),P =0.028)had a higher risk of rebleeding,and a high admission GCS score(OR = 15.430,95CI%(1.377 ~ 172.900),P = 0.026).Limited by the small number of cases,this study could not draw a conclusion that the surgical method has statistical correlation with the patient’s prognosis and rebleeding.Therefore,we described our hospital’s single-center treatment experience with typical cases.Conclusions This article recorded and described the clinical characteristics of patients with moyamoya disease and aneurysms,and found that the admission GCS score is related to the incidence of short-term complications,and rebleeding can significantly affect the prognosis of neurological function.We also found that the admission GCS score and the range of smoke-like blood vessels were related to the patient’s rebleeding.Previous bleeding history was a potential risk factor for patients’ rebleeding.There are many treatments for moyamoya disease with aneurysms,and the best treatment plan should be selected according to the situation of different patients. |
PDF Full Text Request