| 1. BackgroundMoyamoya disease is a cerebral vasculopathy characterized mainly by progressive narrowing of the major intracranial vessels, including the distal part of ICA and the beginning of MCA and ACA. It is a common disease in the field of neurosurgery whose etiology remains unknown. The current therapy includes medical and surgical management. The multi-burr operation is a newly developed therapy, which has its advantages compared with other kinds of operations. For example, the procedure is relatively simple, the complication and impair caused by operation is minimized. Also, the location and number of burrs are decided by the outcome of DSA or ECT and are not limited in the areas supplied by MCA.2. PurposeIn this research, patients are divided into operation group who underwent multiple bur-operations and control group who did not. Before operation, the general information is recorded. After 3 months, every patient is interviewed by telephone. The clinical outcome is graded and analyzed by statistical method to evaluate the effect of this kind of operation.3. Objective and methodsRetrospectively analyze the data of 16 patients who had MMD and admitted to the second affiliated hospital of ShanDong University from Mar.2007 to Jan.2010. All the patients are confirmed by DSA and 7 cases were performed with this kind of surgery. Among them 6 patients have single operations and 1 has bilateral side. The number and location of burrs are dependent by the ischemic areas evaluated by CT perfusion or SPECT. Before operation, patients will have some routine tests, CT and MRI scan, analysis of cerebral metabolism by CT perfusion or SPECT et al. The Suzuki stage of preoperative DSA is recorded. And after 3 months, the improvement of the symptoms is documented through interviews by telephone. According to the given criterion, the outcomes can be classified into 4 groups:excellent, good, common and poor. And the differences of the outcomes between the two groups are examined with fisher test.4. Outcome15 patients are adults,42 years old on average. The ratio of male to female is 1:2.2 and ischemic to hemorrhagic is 1.3:1. All the patients are confirmed to be moyamoya disease and moyamoya syndrome with specific causes is excluded from this group. There are 14 patients whose cerebral metabolism is abnormal. DSA shows that 12 patients have bilateral diseases while 4 patients have vascular abnormality in single side. The Suzuki stage of 28 hemispheres are as follows:stage 1:2 sides; stage 2:3 sides; stage 3:8 sides; stage 4:6 sides; stage 5:6 sides; stage 6:3 sides. The average time for an operation is about 2 hours or so. After surgery, we observed 2 patients who underwent TIA. One felt his right limb numb which lasted 7 minutes or so. The other experienced decreased muscle strength aboutâ…¡toâ…¢degree and lasted 2 hours or so. All the other patients did not undergo the similar symptoms. The results of interview are as follows. In the operation group, excellent:2 cases, good:4 cases; common:1 case; poor:0 case; in the control group, excellent:0 cases, good:2 cases; common:3 cases; poor:4 cases. The differences of the outcomes between the two groups are examined with fisher test, p<0.05, which means there are significant differences between the two groups in term of the surgical outcome of this kind of operation.5. Conclusion1. The clinical symptom of adult patient can be classified into hemorrhagic or ischemic type. The peak age is about 40. DSA remains the golden diagnostic criterion which can not only evaluate ischemic or occlusion vessels, moyamoya vessels and the extent of revascularization, but also can detect aneurism and the possible hemorrhagic vessels. When diagnosing MMD, MMD syndrome should be excluded which is caused by some diseases with specific causes.2. The multiple burr-operation has a definite efficiency. In this group, patients have improved symptoms and no hemorrhagic events happened again after the operation. Compared with other kinds of surgical management, patients have fewer complications and a shorter time in hospital and thus spend less money.3. 2 patients have episodes of TIA. after surgery, at a rate of 28.5%. It may occur as a result of the damages to the vesicle bypass formed before. The specific mechanism still remains unknown and yet to be researched.4. In this group the outcomes between the operation group and control group have significant differences in statistics which means the effect of this kind of operation is reliable.
|
PDF Full Text Request