经颅多普勒超声对颞浅-大脑中动脉搭桥术近期效果的评测
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摘要
目的探讨经颅多普勒超声(TCD)在颞浅动脉-大脑中动脉搭桥术(STA-MCA)治疗烟雾病(MMD)效果评价中的应用。方法对58例MMD的患者行STA-MCA治疗,于术前1d、术中血管吻合前后、术后8d给予TCD监测,术后及术后3个月行CTA随访术后疗效。结果术后MCA狭窄处流速较术前降低(P<0.05),频谱形态较术前好转,且狭窄远心端血流方向逆转证实MCA远端由STA向颅内供血;术中STA与MCA吻合前后STA血流速度无明显变化(P>0.05),术后8d STA血流速度较术前明显增快(P<0.05),说明术后经过血流动力学的改变及血流再分配,颅外动脉血通过STA向颅内MCA远端缺血区域供血,并且明显改善缺血症状。结论通过监测颅内血流的频谱及流速的改变,经颅多普勒超声可以有效评价STA-MCA的手术效果。
Objective To investigate the application of transcranial Doppler ultrasonography(TCD) in evaluating the effect of superficial temporal artery-middle cerebral artery(STA-MCA) bypass surgery on the treatment of moyamoya disease(MMD). Method 58 patients with MMD were treated with STA-MCA bypass,TCD were applied on the day before the operation, before and after intraoperative vascular anastomosis in the operation and 7-10 days after the operation. CTA was applied 3 rd month after operation. Results TCD showed that the velocity of MCA was lower than that before operation(P<0.05), the spectral morphology was improved compared with preoperative, and reversed flow direction in distal branch of MCA confirmed that blood was supplied from STA to distal MAC. There was no significant change in STA blood flow velocity before and after anastomosis in the operation(P>0.05),but the blood flow velocity 7 th day after operation of STA was significantly faster than that before operation(P<0.05),indicating that extracranial arterial blood was supplied from STA to distal MAC and significantly improved ischemic symptoms after hemodynamics changes and blood flow redistribution. Conclusion By monitoring the intracranial blood flow spectrum and flow rate changes, TCD can effectively evaluate the effect of STA-MCA bypass surgery.
Objective To investigate the application of transcranial Doppler ultrasonography(TCD) in evaluating the effect of superficial temporal artery-middle cerebral artery(STA-MCA) bypass surgery on the treatment of moyamoya disease(MMD). Method 58 patients with MMD were treated with STA-MCA bypass,TCD were applied on the day before the operation, before and after intraoperative vascular anastomosis in the operation and 7-10 days after the operation. CTA was applied 3 rd month after operation. Results TCD showed that the velocity of MCA was lower than that before operation(P<0.05), the spectral morphology was improved compared with preoperative, and reversed flow direction in distal branch of MCA confirmed that blood was supplied from STA to distal MAC. There was no significant change in STA blood flow velocity before and after anastomosis in the operation(P>0.05),but the blood flow velocity 7 th day after operation of STA was significantly faster than that before operation(P<0.05),indicating that extracranial arterial blood was supplied from STA to distal MAC and significantly improved ischemic symptoms after hemodynamics changes and blood flow redistribution. Conclusion By monitoring the intracranial blood flow spectrum and flow rate changes, TCD can effectively evaluate the effect of STA-MCA bypass surgery.
引文
[1]Guidelines for diagnosis and treatment of moyamoya disease(spontaneous occlusion of the circle of Willis)[J].Neurol Med Chir(Tokyo),2012,52(5):245-266.
[2]Suzuki J,Takaku A.Cerebrovascular"moyamoya"disease.disease showing abnormal net-like vessels in base of brain[J].Arch Neurol,1969,20(3):288-299.
[3]Cooperberg E B,Rudenev I N,Lavrentev A V,et al.Evaluation of haemodynamic effects of extracranial-intracranial arterial bypass in unilateral internal carotid artery occlusion[J].Cardiovasc Surg,1993,1(6):704-708.
[4]Jeon J P,Kim J E,Cho W S,et al.Meta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults[J].JNeurosurg,2018,128(3):793-799.
[5]段炼,史万超,咸鹏,等.成人烟雾病临床特征分析[J].中国卒中杂志,2008,15(7):472-476.
[6]王忠诚.王忠诚神经外科学[M].湖北:湖北科学技术出版社,2005,846-847.
[7]Ullah S,Siddiqui A A,Alkilani W Z,et al.Non-atherosclerotic obliteration of bilateral supraclinoid internal carotid arteries;a classic case of moyamoya disease[J].J Ayub Med Coll Abbottabad,2017,29(2):363-365.
[8]Lee H S,Seol H J,Kong D S,et al.Moyamoya syndrome precipitated by cranial irradiation for craniopharyngioma in children[J].JKorean Neurosurg Soc,2011,50(6):535-537.
[9]Scott R M,Smith E R.Moyamoya disease and moyamoya syndrome[J].N Engl J Med,2009,360(12):1226-1237.
[10]Kwon W K,Kwon T H,Park D H,et al.Efficacy of superficial temporal artery-middle cerebral artery bypass in cerebrovascular steno-occlusive diseases:Hemodynamics assessed by perfusion computed tomography[J].Asian J Neurosurg,2017,12(3):519-524.
[11]Kuroda S,Kawabori M,Miyamoto M,et al.Revascularization surgery for moyamoya disease with cerebral ischemia in temporo-occipital lobes[J].Surgery Cerebral Stroke,2009,37(5):345-349.
[12]Deng X,Gao F,Zhang D,et al.Effects of different surgical modalities on the clinical outcome of patients with moyamoya disease:a prospective cohort study[J].J Neurosurg,2018,128(5):1327-1337.
[13]Vajkoczy P.Revival of extra-intracranial bypass surgery[J].Curr Opin Neurol,2009,22(1):90-95.
[14]Amin-Hanjani S,Barker F N,Charbel F T,et al.Extracranialintracranial bypass for stroke-is this the end of the line or a bump in the road?[J].Neurosurgery,2012,71(3):557-561.
[15]Jang D K,Lee K S,Rha H K,et al.Bypass surgery versus medical treatment for symptomatic moyamoya disease in adults[J].JNeurosurg,2017,127(3):492-502.
[16]Greenwood S,Deane C,Rees O L,et al.The significance of inadequate transcranial Doppler studies in children with sickle cell disease[J].PLoS One,2017,12(7):e181681.
[17]Harders A,Gilsbach J.Transcranial Doppler sonography and its application in extracranial-intracranial bypass surgery[J].Neurol Res,1985,7(3):129-141.
[18]Cho H,Jo K I,Yu J,et al.Low flow velocity in the middle cerebral artery predicting infarction after bypass surgery in adult moyamoya disease[J].J Neurosurg,2017,126(5):1573-1577.
[2]Suzuki J,Takaku A.Cerebrovascular"moyamoya"disease.disease showing abnormal net-like vessels in base of brain[J].Arch Neurol,1969,20(3):288-299.
[3]Cooperberg E B,Rudenev I N,Lavrentev A V,et al.Evaluation of haemodynamic effects of extracranial-intracranial arterial bypass in unilateral internal carotid artery occlusion[J].Cardiovasc Surg,1993,1(6):704-708.
[4]Jeon J P,Kim J E,Cho W S,et al.Meta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults[J].JNeurosurg,2018,128(3):793-799.
[5]段炼,史万超,咸鹏,等.成人烟雾病临床特征分析[J].中国卒中杂志,2008,15(7):472-476.
[6]王忠诚.王忠诚神经外科学[M].湖北:湖北科学技术出版社,2005,846-847.
[7]Ullah S,Siddiqui A A,Alkilani W Z,et al.Non-atherosclerotic obliteration of bilateral supraclinoid internal carotid arteries;a classic case of moyamoya disease[J].J Ayub Med Coll Abbottabad,2017,29(2):363-365.
[8]Lee H S,Seol H J,Kong D S,et al.Moyamoya syndrome precipitated by cranial irradiation for craniopharyngioma in children[J].JKorean Neurosurg Soc,2011,50(6):535-537.
[9]Scott R M,Smith E R.Moyamoya disease and moyamoya syndrome[J].N Engl J Med,2009,360(12):1226-1237.
[10]Kwon W K,Kwon T H,Park D H,et al.Efficacy of superficial temporal artery-middle cerebral artery bypass in cerebrovascular steno-occlusive diseases:Hemodynamics assessed by perfusion computed tomography[J].Asian J Neurosurg,2017,12(3):519-524.
[11]Kuroda S,Kawabori M,Miyamoto M,et al.Revascularization surgery for moyamoya disease with cerebral ischemia in temporo-occipital lobes[J].Surgery Cerebral Stroke,2009,37(5):345-349.
[12]Deng X,Gao F,Zhang D,et al.Effects of different surgical modalities on the clinical outcome of patients with moyamoya disease:a prospective cohort study[J].J Neurosurg,2018,128(5):1327-1337.
[13]Vajkoczy P.Revival of extra-intracranial bypass surgery[J].Curr Opin Neurol,2009,22(1):90-95.
[14]Amin-Hanjani S,Barker F N,Charbel F T,et al.Extracranialintracranial bypass for stroke-is this the end of the line or a bump in the road?[J].Neurosurgery,2012,71(3):557-561.
[15]Jang D K,Lee K S,Rha H K,et al.Bypass surgery versus medical treatment for symptomatic moyamoya disease in adults[J].JNeurosurg,2017,127(3):492-502.
[16]Greenwood S,Deane C,Rees O L,et al.The significance of inadequate transcranial Doppler studies in children with sickle cell disease[J].PLoS One,2017,12(7):e181681.
[17]Harders A,Gilsbach J.Transcranial Doppler sonography and its application in extracranial-intracranial bypass surgery[J].Neurol Res,1985,7(3):129-141.
[18]Cho H,Jo K I,Yu J,et al.Low flow velocity in the middle cerebral artery predicting infarction after bypass surgery in adult moyamoya disease[J].J Neurosurg,2017,126(5):1573-1577.