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| Efficacy comparison of two vascular reconstructions on the treatment for adult Moyamoya disease |
| LI Hongkai XU Haitao YANG Sheng ZHANG Xiangyang HUANG Shulan▲ |
| Department of Neurosurgery, Renmin Hospital of Wuhan University, Hubei Province, Wuhan 430060, China |
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Abstract Objective To compare the efficacy of Superficial temporal artery-middle cerebral artery anastomosis combining with original encephaloduromyosynangiosis (STA-MCA+EDMS) and encephalo-duro-arterio-myo-synangiosis (EDAMS) on the treatment for adult Moyamoya disease. Methods Seventy-three clinical cases of adult Moyamoya disease treated with vascular reconstruction in Wuhan People Hospital from April 2013 to April 2017 were enrolled for retrospective analysis. On the basis of different treatments, they were divided into two groups, STA-MCA+EDMS group with 35 cases and EMDS group with 38 cases. Digital subtraction angiography (DSA) results, computed tomography perfusion (CTP) results, modified Rankin scale (mRS) scores and treatment effecacy were compared between the two groups. Postoperative complications and follow-up results were recorded and compared. Results Revascularization was better in STA-MCA+EDMS group than the EMDS group, the difference was significant (P ＜ 0.05). Cerebral blood flow (CBF) value in the STA-MCA+EDMS group: 2 weeks post-operation was higher than that of 3 months post-operation; 3 months post-operation was higher than that before operation; 3 months post-operation was higher than that of 2 weeks post-operation; all the differences were statistically significant (P ＜ 0.05). The mRS scores in the STA-MCA+EDMS group: the scores before operation was higher than that of 3 months post-operation; 2 weeks post-operation scores higher than that of 3 months post-operation; the scores before operation was higher than that of 2 weeks post-operation; all the differences were statistically significant (P ＜ 0.05). The mRS scores in the EDAMS group: the scores before operation was higher than that of 3 months post-operation; 2 weeks post-operation scores higher than that of 3 months post-operation; the differences were significant (P ＜ 0.05). The scores before operation was higher than that of 2 weeks post-operation, and the difference had no significance (P ＞ 0.05). The mRS scores of 2 weeks post-operation in the STA-MCA+EDMS group was lower than that of EDAMS group, and the difference had no significance (P ＞ 0.05). The mRS scores of 3 month post-operation in the STA-MCA+EDMS group was lower than that of EDAMS group, and the difference was significant (P ＜ 0.05). Perioperative complication rate in the EDAMS group was lower than the STA-MCA+EDMS group; postoperative recurrent rate in the STA-MCA+EDMS group was lower than the EDAMS group; and the differences had no significance (P ＞ 0.05). Conclusion Compared to EDAMS, STA-MCA+EDMS has prominent efficacy in short period post operation. STA-MCA+EDMS builds collateral circulation better and improves patients’ neural symptoms. Perioperative complication rate and postoperative recurrent rate in the two groups have no differences. The long-term efficacy is expected to be observed.
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