目的:描述患有烟雾病的小儿后脑血管重建术的手术技术。这里,我们描述了临床特征,手术适应症,手术技术,以及一系列影响大脑后动脉(PCA)区域的烟雾病儿科患者的临床和影像学结果。
方法:回顾了2009年7月至2019年8月到我们研究所就诊的所有烟雾病儿科患者的回顾性单中心系列。临床特点,手术适应症,手术技术,收集并分析患有PCA区域缺血的小儿烟雾患者的长期临床和影像学结局。
结果:9例患者共进行了10次PCA血运重建手术,5女,年龄1至11.1岁(平均5.2岁)。并发症包括1次中风,没有感染,出血,癫痫发作,或死亡。一名患者的影像学和临床随访时间不到1年。在9例患者中,有8例接受了至少1年的影像学随访,所有病例均存在手术血管植入。尽管疾病的影像学进展,但在长期随访中未发现新的中风。在可用于分析的8个案例中,平均随访50.8个月,随访时间12~117个月.
结论:进行性烟雾病患者的PCA区域缺血可以通过间接血运重建手术治疗。这里,我们描述了我们对烟雾病的PCA血运重建程序的经验,包括颅膜周围硬脑膜(PipeD)血运重建和利用枕动脉的软脑膜新生血管。这些手术选择可能有助于降低患有严重后循环疾病的小儿烟雾患者的中风风险。
OBJECTIVE: To describe a surgical technique for posterior cerebral revascularization in pediatric patients with moyamoya arteriopathy. Here, we describe the clinical characteristics, surgical indications, operative techniques, and clinical and radiographic outcomes in a series of pediatric patients with moyamoya disease affecting the posterior cerebral artery (PCA) territory.
METHODS: A retrospective single-center series of all pediatric patients with moyamoya disease who presented to our institute between July 2009 through August 2019 were reviewed. The clinical characteristics, surgical indications, operative techniques, and long-term clinical and radiographic outcomes of pediatric moyamoya patients with PCA territory ischemia were collected and analyzed.
RESULTS: A total of 10 PCA revascularization procedures were performed in 9 patients, 5 female, ages 1 to 11.1 years (average 5.2 years). Complications included 1 stroke, with no infections, hemorrhages, seizures, or deaths. One patient had less than 1 year of radiographic and clinical follow-up. In 8 of 9 patients with at least 1 year of radiographic follow-up, there was engraftment of surgical vessels present in all cases. No new strokes were identified on long-term follow-up despite the radiographic progression of the disease. In the 8 cases available for analysis, the average follow-up was 50.8 months with a range of 12 to 117 months.
CONCLUSIONS: PCA territory ischemia in patients with progressive moyamoya disease can be surgically treated with indirect revascularization. Here, we describe our experience with PCA revascularization procedures for moyamoya disease, including pial pericranial dural (PiPeD) revascularization and pial synangiosis utilizing the occipital artery. These surgical options may be useful for decreasing the risk of stroke in pediatric moyamoya patients with severe posterior circulation disease.