Clinical Study Of Indirect Vascular Revascularization In The Treatment Of Moyamoya Disease

Objective:Moyamoya disease(MMD)is a chronic occlusive cerebrovascular disease with unknow etiology characterized by steno-occlusive changes at the terminal portion of the internal carotid artery(ICA)and an abnormal vascular network at the base of the brain.In 1957,it was first proposed by Japanese scholar Shimizu and Takakuchi to describe the angiographic appearances of abnormal branches located in the Willis ring and the bifurcation of intracranial artery.This disease with bilateral internal carotid artery stenosis at the end as the main feature,which initially showed bilateral optic bed of carotid artery stenosis,accompanied by moyamoya formation,is shown as "smoke" in the form of angiography,so some scholars call it Moyamoya diseases.Progress gradually,artery and posterior cerebral artery involvement in the brain,resulting in the carotid artery and its branch vessels disappeared,similar to smoke like blood vessels also eventually disappear.These pathological changes in blood vessels can lead to ischemic and hemorrhagic stroke..Since 1957,the first report on study of moyamoya disease for more than 60 years,has a clear definition and diagnostic criteria,with the popularity of clinical imaging examination technology,moyamoya disease detection rate rise,but on the surgical treatment of moyamoya disease the way Shang Wuming is the unified standard,can be divided into direct bypass surgery,indirect bypass surgery and combined surgery,including encephaloduromy artery connected surgery is an indirect bypass surgery is the most commonly used.Through this study,we discuss the operation way of initial symptoms,clinical manifestations of moyamoya disease,at the same time,combined with 24 cases of surgical techniques of encephaloduromy arterial synangiosis for treatment of moyamoya disease and clinical efficacy.Mehtods:The clinical data of 24 patients with moyamoya disease in Shandong Qianfoshan hospital from February 2014 to February 2016 were retrospectively analyzed,,including age,sex,first symptoms,DSA results.All patients were treated with cerebral dural artery vascular connection,and DSA was reexamined after 3-12 months.Results:(1)This group of cases are all adult patients,the onset age peak at about 43 years old,male and female sex ratio 7:5;(2)The most common adult patients with symptoms of hemorrhagic cerebrovascular disease,a total of 14 cases(58.3%),including headache and vomiting in 14 cases,4 cases with mental disorder,9 cases no body activities(3)Incidence in 10(41.7%)patients presented with ischemic cerebrovascular disease.The main symptoms are numbness,hemiplegia,slurred speech,etc;(4)The patients were examined with DSA,including 24 cases of bilateral lesions,22 cases of patients with abnormal skull base moyamoya vascular network;(5)In 2 cases(8.3%)with aneurysm;(6)24 patients underwent EDAS surgery,with no recurrence after operation.Conclusion:(1)The main clinical manifestations of moyamoya disease were hemorrhagic symptoms;(2)The DSA is the gold standard in the diagnosis of moyamoya disease;(3)MRA and PWI have important clinical value in screening and prognosis of patients with moyamoya disease;(4)EDAS is an effective way to treat moyamoya disease,which has the advantages of simple operation,short operation time,less trauma and no destruction of the original collateral circulation...