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Abstract：
OBJECTIVE: Abnormal collateral channels, so-called moyamoya vessels, play a critical role to compensate cerebral ischemia, but carry the risk for hemorrhagic stroke in moyamoya disease (MMD). The present study was aimed to clarify if superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and encephalo-myo-duro-arterio-pericranial synangiosis (EDMAPS) can efficiently regress the abnormal collateral channels in MMD patients.
METHODS: This study included 92 hemispheres of 61 MMD patients who underwent STA-MCA anastomosis combined with EDMAPS between 2013 and 2019. There were 17 children and 44 adults. We retrospectively analyzed the findings on cerebral angiography before and 3 to 6 months after surgery, including Suzuki\'s angiographical stage, the development of surgical collaterals, and the extent of abnormal collateral channels such as lenticulostriate, thalamic, and choroidal channels.
RESULTS: Following surgery, no pediatric and adult patients experienced any stroke during follow-up periods (40.2±25.5 and 54.9±19.7 months, respectively). Suzuki\'s stage significantly advanced in both adult and pediatric patients after surgery (P=0.042 and P<0.001). In adult patients, all of the lenticulostriate, thalamic, and choroidal channels significantly regressed after surgery (P<0.001, P=0.012, and P=0.004, respectively). In pediatric patients, however, lenticulostriate and choroidal channels significantly regressed (P=0.005 and P=0.034, respectively). Correlation analysis revealed that the development of surgical collaterals determined the postoperative regression of choroidal channels (P<0.001).
CONCLUSIONS: STA-MCA anastomosis and EDMAPS may be one of the most effective procedures to widely provide surgical collaterals to the operated hemispheres and prevent not only ischemic but also hemorrhagic stroke by regressing the hemorrhage-prone abnormal collateral channels in MMD.
METHODS: This study included 92 hemispheres of 61 MMD patients who underwent STA-MCA anastomosis combined with EDMAPS between 2013 and 2019. There were 17 children and 44 adults. We retrospectively analyzed the findings on cerebral angiography before and 3 to 6 months after surgery, including Suzuki\'s angiographical stage, the development of surgical collaterals, and the extent of abnormal collateral channels such as lenticulostriate, thalamic, and choroidal channels.
RESULTS: Following surgery, no pediatric and adult patients experienced any stroke during follow-up periods (40.2±25.5 and 54.9±19.7 months, respectively). Suzuki\'s stage significantly advanced in both adult and pediatric patients after surgery (P=0.042 and P<0.001). In adult patients, all of the lenticulostriate, thalamic, and choroidal channels significantly regressed after surgery (P<0.001, P=0.012, and P=0.004, respectively). In pediatric patients, however, lenticulostriate and choroidal channels significantly regressed (P=0.005 and P=0.034, respectively). Correlation analysis revealed that the development of surgical collaterals determined the postoperative regression of choroidal channels (P<0.001).
CONCLUSIONS: STA-MCA anastomosis and EDMAPS may be one of the most effective procedures to widely provide surgical collaterals to the operated hemispheres and prevent not only ischemic but also hemorrhagic stroke by regressing the hemorrhage-prone abnormal collateral channels in MMD.
摘要：
目的：侧支通道异常，所谓的烟雾船，在补偿脑缺血中起关键作用，但是烟雾病（MMD）有出血性中风的风险。本研究旨在阐明颞浅动脉至大脑中动脉（STA-MCA）吻合术和脑-肌-硬-动脉-颅内血管合并症（EDMAPS）是否可以有效地逆转MMD患者的异常侧支通道。
方法：本研究纳入了2013年至2019年间接受STA-MCA吻合术联合EDMAPS的61例MMD患者的92个半球。有17名儿童和44名成人。回顾性分析手术前和术后3~6个月的脑血管造影结果,包括铃木的血管造影术阶段，外科络脉的发展，以及异常侧支通道的程度，如豆状纹状体，丘脑,和脉络膜通道。
结果：手术后，在随访期间，没有儿童和成人患者发生任何中风（40.2±25.5和54.9±19.7个月，分别)。Suzuki’s分期在成人和儿童患者术后均显著提前(P=0.042和P<0.001)。在成年患者中，所有的豆芽状，丘脑,手术后脉络膜和脉络膜通道显着消退（分别为P<0.001，P=0.012和P=0.004）。在儿科患者中，然而,镜纹和脉络膜通道显着退化（分别为P=0.005和P=0.034）。相关分析显示，手术络脉的发展决定了术后脉络膜通道的消退（P<0.001）。
结论：STA-MCA吻合术和EDMAPS可能是最有效的方法之一，可以广泛地为手术半球提供手术侧支，并通过逆转MMD中易出血的异常侧支通道，不仅可以预防缺血性中风，还可以预防出血性中风。
方法：本研究纳入了2013年至2019年间接受STA-MCA吻合术联合EDMAPS的61例MMD患者的92个半球。有17名儿童和44名成人。回顾性分析手术前和术后3~6个月的脑血管造影结果,包括铃木的血管造影术阶段，外科络脉的发展，以及异常侧支通道的程度，如豆状纹状体，丘脑,和脉络膜通道。
结果：手术后，在随访期间，没有儿童和成人患者发生任何中风（40.2±25.5和54.9±19.7个月，分别)。Suzuki’s分期在成人和儿童患者术后均显著提前(P=0.042和P<0.001)。在成年患者中，所有的豆芽状，丘脑,手术后脉络膜和脉络膜通道显着消退（分别为P<0.001，P=0.012和P=0.004）。在儿科患者中，然而,镜纹和脉络膜通道显着退化（分别为P=0.005和P=0.034）。相关分析显示，手术络脉的发展决定了术后脉络膜通道的消退（P<0.001）。
结论：STA-MCA吻合术和EDMAPS可能是最有效的方法之一，可以广泛地为手术半球提供手术侧支，并通过逆转MMD中易出血的异常侧支通道，不仅可以预防缺血性中风，还可以预防出血性中风。
