Treatment strategy and efficacy for moyamoya disease of different clinical types and radiographic stages / 第二军医大学学报

ABSTRACT

Objective: To assess the therapeutic strategies and efficacy of moyamoya disease of different clinical types and radiographic stages. Methods: The clinical types, radiographic stages and treatment strategies of 39 patients with moyamoya disease, who were treated in our medical centers from April 2010 to December 2013, were retrospectively analyzed. The treatment efficacies were analyzed by CT angiography, CT perfusion and DSA. The average follow-up time was (21.3±3.1) months (range 7-44 months).Results: Thirty-four patients had type I - V moyamoya disease, including 6 treated by encepho-duro-myo-synangiosis (EDMS) and 28 by STA-MCA anastomosis combined with EDMS, with 4 receiving a second surgery on the other hemisphere 6 months after first surgery. Five patients with type VI moyamoya disease underwent emergency surgery cerebral hematoma evacuation+decompressive craniectomy EDMS. Stage I and II patients were treated by conservative therapies. Stage III - VI patients were treated by EC-IC cerebrovascular reconstruction. The skin incision, bone window, and dura incision were designed individually in order to protect anastomoses formed pre-op in stage V & VI patients. All patients had improved clinical condition during follow-up. CTP imaging showed significantly increased relative cerebral blood flow and relative cerebral blood volume, and decreased time-to-peak after the operation (P<0.05), and these changes were intensified with the prolong of follow-up.Conclusion: Selection of appropriate treatment strategy according to different clinical types and radiographic stages can achieve better therapeutic efficacy for moyamoya disease patients.