Analysis Of Clinical Efficacy Of Multiple Burr Hole With Dural Inversion Surgery Combining With Periosteum Sticking Therapy For Treatment Of Moyamoya Diseaes

1. ObjectiveTo evaluate the therapeutic effect of multiple burr hole with dural inversion surgery combining with periosteum sticking therapy in the treatment of moyamoya disease by contrasting pretreatment and posttreatment clinical symptoms of moyamoya patients in operative group and non-operative group.2. MethodsThe 42 patients were diagnosed by magnetic resonance angiography and digital subtraction angiography form Aug,2004 to Jan,2011. Twenty patients were in the operative group and 22 patients in the non-operative group. Twenty procedures of multiple burr hole with dural inversion surgery combining with periosteum sticking therapy were performed in the operative group and 22 had accepted conservative treatment in the non-operative group. There were eleven male and nine female patients in the operative group and their age ranged from nine to sixty three,41.3 on average. Fifteen bilateral and 5 unilateral impairments were found in 35 cerebral hemispheres. Nine had unilateral surgery and 11 had bialeteral surgery in 20 patients of the operative group. Five male and seventeen female patients were found in the non-operative guoup and their age ranged from twenty four to sixty six,45.0 on average. Nine bilateral and 13 unilateral impairments were found in this group.Eighteen cases of ischemic-type moyamoya patients and 2 cases of hemorrhagic-type moyamoya patients including one case of subarachnoid hemorrhage patients and one case of aneurysm in posterior choroidal artery were in operative group. Twelve patients had dysfunction of neurological system. Three cases of ischemic-type moyamoya patients and 19 cases of hemorrhagic-type patients were in the non-operative group. The 19 cases of hemorrhagic-type patients including 4 cases of subarachnoid hemorrhage patients,6 cases of ventricular hemorrhage patients,3 cases of cerebral hemorrhage broken into ventricles of brain and 6 cases ventricular hemorrhage patients. One case of aneurysm in anterior choroidal artery and one case of aneurysm in cerebral artery were found in the non-operative group. Twenty patients had dysfunction of neurological system. Follow-up study has been doing by clinic, telephone and DSA reexamination from 2 to 78 months,22.5months on average.3. Results①mprovement of clinical symptoms:The original symptoms were relieved in all of ischemic-type moyamoya patients in the operative group. No rebleeding symptoms was found on follow-up study of the 2 cases of hemorrhagic-type patients. The dysfunction of neurological system in 12 patients had obviously changed and the preoperative and postoperative clinical symptoms of the patient's had statistics differences(P<0.05). While there were 4 rebleeding symptoms and 1 case of TIA symptom were found in non-operative group.Three cases of 4 rebleeding patients were dead. There were significant differences between ischemic-type and hemorrhagic-type group of the improvement of clinical symptoms(P<0.05), and there were no significant differences between ischemic-type and hemorrhagic-type group with the therapy methord(P>0.05).②mprovement of hemodynamics:Collateral vessels from the middle meningeal artery and the superficial temporal artery was found in forty five holes by the angiogram obtained postoperatively in ten patients who got reexamimation of DSA. The original aneurysm was disappeared 10 months postoperatively by the DSA reexamination in one case of aneurysm in posterior choroidal artery. Collateral vessels was also found from the middle meningeal artery and the superficial temporal artery in the patient.4. Conclusions(1) The multiple burr hole with dural inversion surgery combining with periosteum sticking therapy is safe, effective and is a simple measure for the treatment of the Moyamoya disease. It can be used for the treatment of moyamoya diease as an independent operation.(2) This surgery is one of the indirect cerebral revascularization methods and the collateral vessels came from the middle meningeal artery and the superficial temporal artery.(3) The improvement of clinical symptoms of the patient's between the operative group and non-operative group had significant differences.The multiple burr hole with dural inversion surgery combining with periosteum sticking therapy had an reliable effect.(4) There were no significant differences between ischemic-type and hemorrhagic-type group of the improvement of clinical symptoms in the treatment by The multiple burr hole with dural inversion surgery combining with periosteum sticking therapy.