两种手术方案对烟雾病继发颅内动脉瘤临床疗效生活质量及生存时间的影响Influence of two kinds of surgical schemes on the clinical efficacy,quality of life and survival rate of patients with moyamoya disease related intracranial aneurysms
白新学,周国平,郭春燕
摘要(Abstract):
目的探讨血管重建术与腔内栓塞术+对烟雾病继发颅内动脉瘤临床疗效、生活质量及生存时间的影响。方法研究对象选取南阳市中心医院神经外科2010-01—2014-12收治烟雾病继发颅内动脉瘤患者共110例,根据治疗方法不同分为A组(55例)和B组(55例),其中A组采用血管重建术治疗,B组采用腔内栓塞术+血管重建术治疗,比较2组患者临床疗效、手术前后CSS评分、Barthel指数评分、术后改良Rankin量表评分及随访生存率等。结果 B组患者临床疗效显著优于A组(P<0.05);B组患者治疗后CSS评分和Barthel指数评分均显著优于治疗前、A组(P<0.05);B组患者术后改良Rankin量表评分显著优于A组(P<0.05);2组患者随访1 a生存率比较差异无统计学意义(P>0.05);B组患者随访2 a生存率显著高于A组(P<0.05)。结论腔内栓塞术+血管重建术治疗烟雾病继发颅内动脉瘤可有效改善临床症状,促进受损神经功能恢复,提高日常生活质量,并有助于延长生存时间,价值优于血管重建术。
关键词(KeyWords): 血管重建术;腔内栓塞术;烟雾病;颅内动脉瘤
基金项目(Foundation):
作者(Author): 白新学,周国平,郭春燕
参考文献(References):
- [1] KIM T,BANG JS,HWANG G,et al.Idiopathic lenticulostriate artery pseudoaneurysm protruding into the lateral ventricle:a case report[J].J Cerebrovasc Endovasc Neurosurg,2013,15(3):246-250.
- [2] GROSS B A,DU R.The natural history of Moyamoya in a North American adult cohort[J].J Clin Neurosci,2013,20(1):44-48.
- [3] WONG SC,NAWAWI O,RAMLI N,et al.Benefits of 3 D rotational DSA compared with 2 D DSA in the evaluation of intracranial aneurysm[J].J Acad Radiol,2012,19(6):701-707.
- [4] CHALOUHI N,TJOUMAKARIS S,GONZALEZ L F,et al.Onyx embolization of a ruptured lenticulostriate artery aneurysm in a patient with moyamoya disease[J].World Neurosurg,2013,80(3/4):436-437.
- [5] 赵继宗.神经外科学[M].2版.北京:人民卫生出版社,2012:512-516.
- [6] LEE C C,LIU Z H,JUNG S M,et al.Ruptured aneurysm of the accessory middle cerebral artery associated with moyamoya disease:a case report[J].Chang Gung Med J,2011,34(5):541-547.
- [7] 潘扬,曹文锋.烟雾病的诊治进展[J].中国实用神经疾病杂志,2017,20(23):108-112.
- [8] 秦振宇.脑硬脑膜颞浅动脉血管融通术治疗缺血型烟雾病的疗效观察[J].中国实用神经疾病杂志,2016,19(24):81-82.
- [9] KAWAGUCHI S,OKUNO S,SAKAKI T.Effect of direct arterial bypass on the pre-emotion of future stroke in patients with the hemorhagic variety of Moyamoya disease[J].J Neurosurg,2011,93(2):397-401.
- [10] HE K,ZHU W,CHEN L,et al.Management of distal choroidal artery aneurysms in patients with moyamoya disease:report of three cases and review of the literature[J].World J Surg Oncol,2013,11(1):1-6.
- [11] KAPOOR S.The genetics of moyamoya disease:recent insights into the pathogenesis of the disease[J].Neurosurgery,2013,72(2):E320-E321.
- [12] LEVEQUE M,MCLAUGHLIN N,LAROCHE M,et al.Endoscopic treatment of distal choroidal artery aneurysm[J].J Neurosurg,2011,114(1):116-119.
- [13] NISHIDA A,TOKUNAGA K,HISHIKAWA T,et al.Endovascular coil embolization of a ruptured distal anterior choroidal artery aneurysm associated with ipsilateral middle cerebral artery occlusion[J].Neurol Med Chir (Tokyo),2011,51(10):716-719.
- [14] MUKAWA M,NARIAI T,MATSUSHIMA Y,et al.Long-term follow-up of surgically treated juvenile patients with Moyamoya disease[J].J Neurosurg Pediatr,2012,10(5):451-456.
- [15] Arai Y,Matsuda K,Isozaki M,et al.Ruptured intracranial aneurysms associated with moyamoya disease:three case reports[J].Neurol Med Chir,2011,51(11):774-776.
- [16] NI W,XU F,XU B,et al.Disappearance of aneurysms associated with moyamoya disease after STA-MCA anastomosis with encephaloduro myosynangiosis[J].J Clin Neurosci,2012,19(3):485-487.
- [17] IM S H,CHO C B,JOO W I,et al.Prevalence and epidemiological features of moyamoya disease in Korea[J].J Cerebrovasc Endovasc Neruosurg,2012,14(2):75-78.
- [18] MIYAMOTO S,YOSHIMOTO T,HASHIMOTO N,et al.Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease:results of the Japan Adult Moyamoya Trial[J].Stroke,2014,45(5):1 415-1 421.
- [19] OSANAI T,KURODA S,NAKAYAMA N,et al.Moyamoya disease presenting with subarachnoid hemorrhage localized over the frontal cortex:case report[J].Surg Neurol,2008,69(2):197-200.
- [20] KIM Y S,JOO S P,LEE G J,et al.Ruptured choroidal artery aneurysms in patients with moyamoya disease:Two case series and review of the literatures[J].J Clin Neurosci,2017,44:236-239.
- [21] ABURAKAWA D,FUJIMURA M,NIIZUMA K,et al.Navigation-guided clipping of a de novo aneurysm associated with superficial temporal artery-middle cerebral artery bypass combined with indirect pial synangiosis in a patient with moyamoya disease[J].Neurosurg Rev,2017,40(3):517-521.
- [22] KALANI M Y S,SPETZLER R F,WANEBO J E.Keyhole Supraorbital Craniotomy for Aneurysm Clipping in the Setting of Bypass for Moyamoya Disease[J].World Neurosurg,2016,94:442-446.
- [23] YU J,YUAN Y,ZHANG D,XU K.Moyamoya disease associated with arteriovenous malformation and anterior communicating artery aneurysm:A case report and literature review[J].Exp Ther Med,2016,12(1):267-271.
- [24] BIRKELAND P,GARDNER K,KESSE-ADU R,et al.Intracranial Aneurysms in Sickle-Cell Disease Are Associated With the Hemoglobin SS Genotype But Not With Moyamoya Syndrome[J].Stroke,2016,47(7):1 710-1 713.
- [25] LIU P,LV X L,LIU A H,et al.Intracranial Aneurysms Associated with Moyamoya Disease in Children:Clinical Features and Long-Term Surgical Outcome[J].World Neurosurg,2016,94:513-520.
- [26] MéLOT A,CHAZOT J V,TROUDE L,et al.Ruptured posterior ethmoidal artery aneurysm and Moyamoya disease in an adult patient.Case report[J].Neurochirurgie,2016,62(3):171-173.
- [27] MIYAZAKI H,KOHNO K,TANAKA H,et al.A Case of Ruptured Peripheral Cerebral Aneurysm at Abnormal Vessels Associated with Middle Cerebral Artery Stenosis:Similarity to Moyamoya Disease[J].No Shinkei Geka,2016,44(4):311-318.
- [28] SINGH V,NAIK S,SHETTY G S,et al.Anterior spinal artery aneurysm in a case of Moyamoya disease[J].Acta Neurol Belg,2016,116(4):663-665.
- [29] OZAKI S,INOUE A,MIYAZAKI H,et al.Hemorrhagic Adult Unilateral Moyamoya Disease with Multiple Unruptured Intracranial Aneurysms:A Case Report[J].No Shinkei Geka,2016,44(2):121-128.
- [30] DAOU B,CHALOUHI N,TJOUMAKARIS S,et al.Onyx embolization of a ruptured aneurysm in a patient with moyamoya disease[J].J Clin Neurosci,2015,22(10):1 693-1 696.
- [31] LIU P,LV X,LI Y,et al.Onyx Embolization of a Ruptured Rotundum Foreman Artery Aneurysm in a Patient with Moyamoya Disease:A Case Report[J].World Neurosurg,2015,84(4):1 178.e1-3.
- [32] PAVANELLO M,SEVERINO M,D’ANTIGA L,et al.Pretransplant management of basilar artery aneurysm and moyamoya disease in a child with Alagille syndrome[J].Liver Transpl,2015,21(9):1 227-1 230.
- [33] ZHANG L,XU K,ZHANG Y,et al.Treatment strategies for aneurysms associated with moyamoya disease[J].Int J Med Sci,2015,12(3):234-242.
- [34] JIANG H,NI W,LEI Y,et al.Combined extracranial-intracranial bypass surgery with stent-assisted coil embolization for moyamoya disease with a ruptured wide-necked basilar trunk aneurysm:a case report[J].Turk Neurosurg.2015:25(1):180-185.
- [35] OHBA S,SHIBAO S,TOMITA H,et al.Concurrent unilateral moyamoya disease and vertebrobasilar junction aneurysm associated with fenestration -case report and management[J].Clin Neurol Neurosurg,2014,120:113-115.
- [36] HE K,ZHU W,CHEN L,et al.Management of distal choroidal artery aneurysms in patients with moyamoya disease:report of three cases and review of the literature[J].World J Surg Oncol,2013,11(1):187.
- [37] SOUTHERLAND A M,MESCHIA J F,WORRALL B B.Shared associations of nonatherosclerotic,large-vessel,cerebrovascular arteriopathies:considering intracranial aneurysms,cervical artery dissection,moyamoya disease and fibromuscular dysplasia[J].Curr Opin Neurol,2013,26(1):13-28.
- [38] ALURKAR A,KARANAM L S,OAK S,et al.Endovascular treatment of ruptured wide-necked basilar tip aneurysm with Y stenting and coiling in a case of bilateral internal carotid artery occlusion with moyamoya disease[J].Neurol India.2012,60(4):449-50.
- [39] COUGHLIN D J,MILLER C A,SCHUETTE A J.Treatment of Moyamoya Disease and Unruptured Intracranial Aneurysm in Floating-Harbor Syndrome[J].World Neurosurg,2017,104:1049.e1-1049.e6.
- [40] GE P,ZHANG Q,YE X,et al.Clinical Features of Hemorrhagic Moyamoya Disease in China[J].World Neurosurg,2017,106:224-230.
- [41] RHIM J K,CHO Y D,JEON J P,et al.Ruptured Aneurysms of Collateral Vessels in Adult Onset Moyamoya Disease with Hemorrhagic Presentation[J].Clin Neuroradiol,2018,28(2):191-199.
- [42] ZHOU S,AMBALAVANAN A,ROCHEFORT D,et al.RNF213 Is Associated with Intracranial Aneurysms in the French-Canadian Population[J].Am J Hum Genet,2016,99(5):1 072-1 085.
- [43] YU J,YUAN Y,ZHANG D,et al.Moyamoya disease associated with arteriovenous malformation and anterior communicating artery aneurysm:A case report and literature review[J].Exp Ther Med,2016,12(1):267-271.