| ObjectiveTo explore the influential factors of the development of spontaneously developed external carotid artery (ECA) anastomosis and the relationship between spontaneously developed external carotid artery (ECA) anastomosis and the outcomes of Encephalo-duro-arterio-synangiosis (EDAS) in moyamoya disease (MMD).MethodsRetrospectively analyzed the clinical data of patients who had MMD and admitted to PLA 307 hospital in recent years. Clearly diagnostic patients who had the intact data and had underwent EDAS were taken into the group. The following characteristics were recorded: sex, age, onset performance, cerebral ischemia according to preoperative Magnetic Resonance (MR), cerebral metabolism according to preoperative Positron Emission Tomography (PET), Suzuki stage and spontaneously developed ECA anastomosis according to preoperative Digital Subtraction Angiography (DSA), the extent of revascularization according to postoperative DSA. Conclude the sources of blood flow of the spontaneously developed ECA anastomosis. Sex, age, onset performance, preoperative cerebral ischemia, preoperative cerebral metabolism, preoperative Suzuki stage were taken as the variables in the study of the analysis of the influential factors of the development of spontaneously developed ECA anastomosis with genmod. Differences of the outcomes of EDAS between the two groups with and without spontaneously developed ECA anastomosis were examined with wilcoxon rank sum test.Results1. A total of 74 cases of patients were taken into the group, of which 38 cases were male (51.35%), and 36 cases were female (48.65%). Male to female ratio was 1.05:1. The age of the patients range from 4.5 to 48, of which 42 cases were minor (56.75%), and 32 cases were adult (43.25%). 62 cases were ischemic type (83.78%), and 12 cases were hemorrhagic type (16.22%). All patients underwent EDAS bilaterally and were followed up for 3-55months with a mean of 15.1 months. In this group, women, minor and ischemic type were more than men, adult and hemorrhagic type respectively. Preoperative MR showed that 98 sides of the hemisphere of the total 148 sides were cerebral ischemia. Preoperative PET showed that 106 sides of the hemisphere of the total 148 sides were abnormality of cerebral metabolism. Preoperative DSA showed that a total of 148 sides of the hemisphere were graded according to Suzuki stage, of which 14 hemispheres were stageⅠ; 21 hemispheres were stageⅡ; 38 hemispheres were stageⅢ; 33 hemispheres were stageⅣ; 28 hemispheres were stageⅤ; 14 hemispheres were stageⅥ.2. According to preoperative DSA, 92 sides of the hemisphere of the total 148 sides have spontaneously developed ECA anastomosis, of which 50 sides were left hemispheres and 42 sides were right hemispheres. 2 sides showed anastomoses from maxillary arteries; 1 sides showed anastomoses from maxillary and occipital arteries; 1 sides showed anastomoses from maxillary and middle meningeal arteries; 53 sides showed anastomoses from middle meningeal arteries; 9 sides showed anastomoses from middle meningeal and superficial temporal arteries; 9 sides showed anastomoses from middle meningeal and occipital arteries; 1 sides showed anastomoses from middle meningeal, superficial temporal and occipital arteries; 1 sides showed anastomoses from middle meningeal, occipital and maxillary arteries; 7 sides showed anastomoses from superficial temporal arteries; 6 sides showed anastomoses from occipital arteries; 2 sides showed anastomoses from superficial temporal artery to occipital arteries. Anastomoses from middle meningeal arteries, the largest share in ECA collateral circulation, accounted for 57.6%.3. All patients underwent EDAS bilaterally. A total of 148 sides of the operative hemisphere were graded according to the extent revascularization, of which 32 hemispheres were stage 0; 26 hemispheres were stageⅠ; 38 hemispheres were stageⅡ; 52 hemispheres were stageⅢ.4. The development of spontaneously developed ECA anastomosis was significantly affected by preoperative Suzuki stage. The standard regression coefficients is -0.3322, p<0.05. The patients who had higher Suzuki stage were more likely to develop ECA anastomosis than the patients who had lower stage. And other factors, such as sex, age, onset performance, were unrelated to the spontaneously developed ECA anastomosis (P > 0.05).5. A total of 148 sides of operative hemispheres were grouped according to spontaneously developed ECA anastomosis, of which 92 hemispheres were taken into the group with anastomosis, and 56 were involved in non-anastomosis group. According to the extent of the revascularization, the group with anastomosis includes 12 sides in stage 0, 12 sides in stageⅠ, 23 sides in stageⅡ, 45 sides in stageⅢ; and the group without anastomosis includes 20 sides in stage 0, 14 sides in stageⅠ, 14 sides in stageⅡ, 8 sides in stageⅢ. There was a statistically significant difference between the two groups with and without spontaneously developed ECA anastomosis, Z=-4.73,P<0.0001.Conclusion1. Have the MMD patients got the spontaneously developed ECA anastomosis, the anastomosis would commonly be the one or composition of several sources blood flow: Anastomosis from the superficial tempral artery and middle meningeal arteries to the cortex of the middle cerebral artery; Anastomosis from the maxillary artery to the cortex of the skull base; And anastomosis from the occipital artery to the cortex of the occipital lobe.2. The development of spontaneously developed ECA anastomosis was significantly affected by preoperative Suzuki stage.3. The group with spontaneously developed ECA anastomosis was superior than the one without spontaneously developed ECA anastomosis in the outcomes of EDAS.4. Spontaneously developed ECA anastomosis can be used as one of the predicator of the outcomes of EDAS, helping select and adjust the surgical approach before the surgery to optimize the treatment. |
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