Efficacy of modified encephalo-duro-arterio-synangiosis combined with superficial temporal fascia attachment-dural reversal surgery in precise treatment of ischemic cerebrovascular disease / 中华神经医学杂志

Objective:To investigate the efficacy of modified encephalo-duro-arterio-synangiosis (EDAS) combined with superficial temporal fascia attachment-dural reversal surgery in treatment of ischemic cerebrovascular diseases.Methods:Twenty-four patients with ischemic cerebrovascular diseases, admitted to our hospital from December 2018 to June 2020, were selected. Their clinical data were retrospectively analyzed. All patients were treated by modified EDAS combined with superficial temporal fascia attachment-dural reversal surgery. CT cerebral perfusion (CTP) was re-examined 3 months after surgery to detect intracranial cerebral blood flow perfusion. Cephalic DSA was re-examined 6 months after surgery to observe the collateral circulation. Modified Rankin scale (mRS) was used to evaluate the good prognosis rate 6 months after surgery (mRS scores≤2 was defined as good prognosis).Results:Preoperative cerebral blood flow (CBF), time to peak of regional blood flow (rTTP), and regional mean transit time (rMTT) of 24 patients were (26.91±8.77) mL/(100 g·min), 17.57 (15.30, 19.55) s and 7.89 (6.39, 11.45) s; 3 months after surgery, the CBF, rTTP and rMTT were (33.74±11.23) mL/(100 g·min), 16.22 (13.84, 18.44) s, 6.16 (5.20, 10.38) s; significant differences were noted between the preoperative indexes and indexes 3 months after surgery ( P<0.05). Re-examination of the cranial DSA 6 months after surgery showed successful establishment of intracranial collateral circulation in all patients, and the good prognosis rate 6 months after surgery was87.5%. Conclusion:Modified EDAS combined with superficial temporal fascia attachment-dural reversal surgery is an effective method for ischemic cerebrovascular diseases, which can significantly increase the establishment of collateral circulation in the surgical area and prognosis of ischemic cerebrovascular diseases.

Assessment of effect of encephalo-duro-arterio-synangiosis on moyamoya disease by CT perfusion / 中华神经医学杂志

Objective:To evaluate the utility of CT perfusion (CTP) for assessment of effect of encephalo-duro-arterio-synangiosis (EDAS) on moyamoya disease (MMD).Methods:Thirty-eight adult MMD patients, who underwent EDAS in our hospital from March 2014 to October 2019, were chosen in our study. All patients received CTP and digital subtraction angiography (DSA) before and after surgery; cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TTP) in the operative cerebral cortices and their contralateral mirror areas, as well as brainstems were measured respectively; their relative parameter values (rCBF, rCBV, rMTT and rTTP) were calculated with the brainstem as the reference; perfusion changes of cerebral tissues were observed before and after surgery, and efficacies of these parameters in evaluating the surgical treatment effect were compared. According to the degrees of collateral formation detected by postoperative DSA, the 42 hemispheres of these patients were divided into group of good collateral formation and group of poor collateral formation, and the differences of perfusion changes in the two groups were further discussed.Results:CTP revealed that cerebral perfusion at surgical side after EDAS was significantly improved in all the 42 hemispheres; significantly increased rCBF, and significantly decreased rMTT and rTTP were noted as compared with those before surgery ( P<0.05). Receiver operating characteristic (ROC) curve showed that the area under the curve of rTTP (0.897) was the largest among all parameters, with diagnostic sensitivity of 87.5% and specificity of 80.8%. Twenty-six patients (61.9%) were into the group of good collateral formation and 16 (38.1%) were into the group of poor collateral formation; changed values of rCBF and rMTT in the group of good collateral formation were significantly better than those in the group of poor collateral formation ( P<0.05). Conclusion:CTP can quantitatively evaluate cerebral hemodynamic changes after EDAS in moyamoya disease patients, and postoperative rTTP changes can reflect the degrees of collateral vessel formation.

Efficacy of superficial temporal artery-anterior temporal artery bypass combined with encephalo-duro-arterio-synangiosis in treatment of moyamoya disease / 中华神经医学杂志

Objective:To investigate the clinical efficacy of superficial temporal artery-anterior temporal artery bypass combined with encephalo-duro-arterio-synangiosis in the treatment of Moyamoya disease.Methods:A total of 42 patients with moyamoya disease, admitted to our hospital from January 2016 to January 2019, were selected and divided into observation group and control group according to surgical management. The patients in the observation group were treated with superficial temporal artery-anterior temporal artery bypass combined with encephalo-duro-arterio-synangiosis, and the patients in the control group were treated with superficial temporal artery-angular gyrus artery bypass combined with encephalo-duro-arterio-synangiosis. The clinical data of these patients were analyzed retrospectively, and the differences of efficacy and safety between the two groups were compared.Results:There was no significant difference in operation time between the two groups ([189.16±21.23] min vs. [179.46±16.95] min, P>0.05). One d after the operation, the patients in both groups were re-examined with CT angiography, and the anastomotic vessels were unobligated. Two patients in the observation group had cerebral infarction in the operative region and one patient in the control group had cerebral infarction in the operative region; no significant difference was noted in the incidence of postoperative complications between the two groups ( P>0.05). The modified Rankin scale (mRS) scores in both groups one month after surgery were significantly decreased as compared with those one d before surgery ( P<0.05); one month after surgery, the mRS scores in observation group (0.13±0.346) were significantly lower than those in the control group (0.42±0.515, P<0.05). Conclusion:The superficial temporal artery-anterior temporal artery bypass combined with encephalo-duro-arterio-synangiosis has definite clinical efficacy in the treatment of moyamoya disease.

Postoperative Transient Neurologic Dysfunction: A Proposal for Pathophysiology

BACKGROUND AND PURPOSE: Sudden neurological deterioration which cannot be explained by structural change, ischemia or seizure is often observed among neurosurgical patients. We aimed to provide new insight into the pathophysiology of postoperative transient neurologic dysfunction. METHODS: We describe prolonged but fully reversible focal neurologic dysfunction of unknown origin based on the initial evaluation in 8 patients who had received encephalo-duro-arterio-synangiosis for moyamoya disease. We performed brain imaging, including diffusion weighted imaging and perfusion magnetic resonance imaging or single photon emission computed tomography, and electroencephalography (EEG) during the episodes and after resolution of the symptoms. RESULTS: The symptoms consisted of dysarthria, hemiparesis, or hemiparesthesia of limbs contralateral to the operated side. These symptoms developed between 12 hours and 8 days after surgery and lasted between 12 hours and 17 days. Structural imaging did not show any significant interval change compared with the immediate postoperative images. Perfusion imaging showed increased cerebral blood flow in the symptomatic hemisphere. EEG revealed low amplitude arrhythmic slowing in the corresponding hemisphere. Follow-up imaging and EEG after recovery did not show any abnormalities. CONCLUSIONS: Transient neurologic dysfunction can occur during the postoperative period of brain surgery. Although this may last more than usual transient ischemic attack or seizure, it eventually resolves regardless of treatment. Based on our observation, we propose that this is the manifestation of the transient cortical depression triggered by mechanical stimulation, analogous to migraine aura associated with cortical spreading depression.

Clinical features and surgical efficacy of moyamoya syndrome in children / 中国脑血管病杂志

Objective Toinvestigatetheclinicalfeaturesandsurgicalprognosisofmoyamoya syndromeinchildren.Methods Theclinicaldataof12childrenwithmoyamoyasyndromeadmittedto the 307th Hospital of People′s Liberation Army from December 2002 to October 2013 were analyzed retrospectively. Eleven of them underwent encephalo-duro-arterio-synangiosis (EDAS). A total of 550 children with moyamoya disease in the same period were used as a control group. The clinical characteristics and surgical efficacy of the children with moyamoya syndrome were summarized and concluded by comparing the clinical data of the two groups,including sex,age of onset,initial symptom,progress symptoms, Suzukiinstallments,imagingfeatures,andsurgicalefficacy.Results Themaleandfemaleratioof the children with moyamoya syndrome was 1∶2. Their mean age of onset was 12 ± 5 years old. There were significant differences in the initial symptom (cerebral infarction and cerebral hemorrhage )and disease progress between the children with moyamoya syndrome group and the control group (5/12 vs. 14. 5%[80/550], 3/12 vs. 61. 8%[340/550],and 5/12 vs. 8.7%[48/550],respectively;all P<0. 05). Within the follow-up period,of the 11 children underwent EDAS,7 cases had no further attack,and 4 cases were improved significantly. There was significant difference in the modified Rankin scale (mRS)between the beforeandaftersurgery(0[0,1]vs.2[1,2];P<0.05).Conclusions Theclinicalfeaturesofthe children with moyamoya syndrome have some differences with those with moyamoya disease. Timely and effective EDAS treatment may effectively prevent disease progression and improve the prognosis of patients.

Evaluation of effect of modified encephalo-duro-arterio-synangiosis on Moyamoya disease patients by single photon emission tomography / 中华神经医学杂志

Objective To evaluate the effects of modified encephalo-duro-arterio-synangiosis (EDAS) on Moyamoya diseases (MMD) by single photon emission tomography (SPECT).Methods Thirty-six patients with MMD (29 with ischemic MMD and 7 with hemorrhagic MMD),admitted to our hospital from January 2011 to December 2013 and treated by modified EDAS,were chosen in our study;all the patients were followed up by SPECT,and the images changes before and after modified EDAS were compared.Results In the 36 MMD patients,41 hemisheres were treated by modified EDAS; the total improvement rate was 56.1％ (23/41),enjoying increased cerebral blood flow after EDAS; in ischemic MMD patients,the total improvement rate was 58.8％ (20/34),while those was 42.9％ (3/7) in hemorrhagic MMD patients.Conclusion The cerebral blood flow is improved obviously when MMD is treated by modified EDAS,especial on ischemic MMD patients.

The Role of Basic Fibroblast Growth Factor in Moyamoya Disease

OBJECTIVES AND OMPORTANCE: The present study investigated the levels of basic fibroblast growth factor(bFGF) in the CSF of patients with moyamoya disease and its clinical significance. METHODS: The levels of bFGF in CSF, taken from 26 hemispheres of 14 moyamoya patients and 20 patients without vascular anomaly(control group), were measured by an enzyme-linked immunosorbent assay. We analyzed the correlation between the level of bFGF and the clinical factors such as age, onset pattern, development of neovascularization, and cerebral circulation. RESULTS: The CSF of moyamoya patients contained a high concentration of bFGF to a significant extent. The bFGF level was apparently elevated in the patients in whom neovascularization from indirect revascularization, such as modified encephalo-duro-arterio-synangiosis(EDAS) was well developed. A linear correlation between the values of bFGF and clinical progression was noted. CONCLUSIONS: The elevation of bFGF in moyamoya disease seems to be specific. Clinically, the bFGF level may be considered a useful indicator to predict the efficacy of indirect revascularization.

Two Operative Cases of Moya Moya Disease in Children

The treatment of moya moya disease, a chronic occlusive cerebrovascular disease of unknown etiology, isn't settled ut various operative methods to maximize cerebral revascularization have been reported. Two cases in children treated surgically are presented, one with cerebroarteriosynangiosis and the other with encephalo-duro-arterio-synangiosis(EDAS). The methods of cerebral revascularization are discussed in detail.

Treatment of Cerebral Rete Mirabile in Children by Encephalo-duro-arterio-synangiosis: Report of Two Operative Cases

Cerebral rete mirabile is a unusual form of chronic cerebrovascular occlusive disease characterized usually by bilateral stenosis of distal internal carotid arteries and their vicinity, by a hazy network of collateral circulation at the base of brain called moyamoya vessels and clinically by recurring hemispheric ischemic attack in children. We have reported here 2 cases of cerebral rete mirabile in children and performed newly developed operative procedure which we think is an ideal surgical method for treatment of this disease in children and is compared with other surgical treatment.