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Nuerlanbieke H, Niyazi A, Wu Q, Yuan Y, Habudele Z, Dun X, Wei R, Aisha A. Efficacy of modified EDAS combined with a superficial temporal fascia attachment-dural reversal surgery for the precise treatment of ischemic cerebrovascular disease. Front Surg 2023; 10:1087311. [PMID: 37066009 PMCID: PMC10090302 DOI: 10.3389/fsurg.2023.1087311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/15/2023] [Indexed: 03/31/2023] Open
Abstract
ObjectiveTo investigate the potential therapeutic benefits of Modified EDAS combined with superficial temporal fascia attachment-dural reversal surgery for the treatment of ischemic cerebrovascular disease.MethodsRetrospective analysis was made on the clinical data of 33 patients with ischemic cerebrovascular disease, who were admitted to the Neurological Diagnosis and Treatment Center of the Second Affiliated Hospital of Xinjiang Medical University from December 2019 to June 2021. All patients were treated with Modified EDAS combined with superficial temporal fascia attachment-dural reversal surgery. At 3 months after operation, the outpatient department rechecked the patient's head CT perfusion imaging (CTP) to understand the intracranial cerebral blood flow perfusion. The DSA of the patient's head was re-examined 6 months after operation to observe the establishment of collateral circulation. The improved Rankin Rating Scale (mRS) score was used to evaluate the good prognosis rate of patients at 6 months after surgery. The mRS score ≤2 was defined as good prognosis.ResultsThe preoperative cerebral blood flow (CBF), local blood flow peak time (rTTP), and local mean transit time (rMTT) of 33 patients were 28.235 ml/(100 g·min), 17.702 s, 9.796 s, respectively. At 3 months after surgery, CBF, rTTP, and rMTT were 33.743 ml/(100 g·min), 15.688, and 8.100 s, respectively, with significant differences (P < 0.05). At 6 months after operation, the establishment of extracranial and extracranial collateral circulation was observed in all patients by re-examination of head DSA. At 6 months after operation, the good prognosis rate was 81.8%.ConclusionThe Modified EDAS combined with superficial temporal fascia attachment-dural reversal surgery is safe and effective in the treatment of ischemic cerebrovascular disease, which can significantly increase the establishment of collateral circulation in the operation area and improve the prognosis of patients.
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Affiliation(s)
- Hanati Nuerlanbieke
- Department of Neurosurgery, The 2th Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ailiyaer Niyazi
- Department of Neurosurgery, The 2th Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qinfen Wu
- Department of Neurosurgery, The 2th Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Neurological Disorder Research, Urumqi, China
- Correspondence: Qinfen Wu Yang Yuan
| | - Yang Yuan
- Department of Neurosurgery, The 2th Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Neurological Disorder Research, Urumqi, China
- Correspondence: Qinfen Wu Yang Yuan
| | - Zanghaer Habudele
- Xinjiang Key Laboratory of Neurological Disorder Research, Urumqi, China
| | - Xiaoyi Dun
- Xinjiang Medical University, Urumqi, China
| | - RuRui Wei
- Department of Neurosurgery, The 2th Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Neurological Disorder Research, Urumqi, China
| | - Abudula Aisha
- Department of Neurosurgery, The 2th Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Neurological Disorder Research, Urumqi, China
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Ovsyannikov KS, Dubovoy AV, Galaktionov DM. Combined (direct and indirect) revascularization in adult patients with moyamoya disease. ACTA ACUST UNITED AC 2018. [DOI: 10.17650/1683-3295-2018-20-3-57-66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The study objective is to analyze the results of combined (direct and indirect) brain revascularization in adult patients with moyamoya disease. Materials and methods. From February 2015 to August 2016, 12 operations were performed on 12 hemispheres in 7 patients (2 men, 5 women) with moyamoya disease. Six patients had bilateral disease, 1 – unilateral. The age of patients ranged from 25 to 60 year old, the average – 41 year old. Multislice computed tomography (MSCT) perfusion imaging of the brain with a stress test was made in every patient, MSCT angiography of the extraand intracranial arteries was perfomed. Stages of the disease were determined according to the Suzuki–Takaku classification: stage III was revealed in 5 patients, stage IV – in 2. To evaluate the clinical course of the disease the Matsushima classification was used: type VI – in 2 cases, type III – in 2, type IV – in 1, type V – in 1. In 1 case, the pathological vascular network of 1 hemisphere was detected by accident. Extracranial-intracranial (EC–IC) bypass and encephaloduromyosynangiosis (EDMS) was used in 3 cases; a double-barreled EC–IC bypass and EDMS – in 3; a double-barreled EC–IC bypass and encephaloduroperiosteomyosynangiosis – in 1; EC–IC bypass and encephaloduroarteriomyosynangiosis (EDAMS) – in 3. In 1 case was perfomed EC–IC bypass and encephaloduroperiosteosynangiosis. Only indirect revascularization was performed in 1 case – EDAMS. We assessed the neurological status in the follow-up period (5–11 months); MSCT angiography and MSCT perfusion imaging of the brain were performed. Results. All patients in follow-up period demonstrated the increase of cerebrovascular reserve according to MSCT perfusion imaging of the brain with stress tests. Stroke, epilepsy, surgical complications were not detected in the postoperative period. In 1 case, the left-hand monoparesis regressed.Conclusion. The combined (direct and indirect) revascularization may be effective in adult patients with moyamoya disease. To obtain more objective conclusions it is necessary to analyze the long-term results of interventions.
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Affiliation(s)
- K. S. Ovsyannikov
- Federal Neurosurgical Center (Novosibirsk), Ministry of Health of Russia
| | - A. V. Dubovoy
- Federal Neurosurgical Center (Novosibirsk), Ministry of Health of Russia
| | - D. M. Galaktionov
- Federal Neurosurgical Center (Novosibirsk), Ministry of Health of Russia
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Choque-Velasquez J, Colasanti R, Kozyrev DA, Hernesniemi J, Kawashima A. Moyamoya Disease in an 8-Year-Old Boy: Direct Bypass Surgery in a Province of Peru. World Neurosurg 2017; 108:50-53. [PMID: 28844915 DOI: 10.1016/j.wneu.2017.08.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 08/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric moyamoya cases may be very arduous, even more so in a developing country, where access to specialized centers may be prevented by different factors. CASE DESCRIPTION Herein we report a challenging case, which was managed in the new Neurosurgical Center of Trujillo, regarding the direct anastomosis between the left superficial temporal artery and a cortical branch of the left middle cerebral artery in a 8-year-old Peruvian boy with moyamoya disease. Postoperatively, the patient's motor deficits and aphasia improved. To the best of our knowledge, this is the first performance of a direct revascularization for a pediatric moyamoya case in Peru. CONCLUSIONS The creation of highly specialized neurosurgical centers in the main strategic places of developing countries may allow optimal treatment of neurosurgical patients with complex diseases.
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Affiliation(s)
- Joham Choque-Velasquez
- Neurosurgical Unit, Es-Salud Trujillo Hospital, La Libertad, Peru; Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
| | - Roberto Colasanti
- Neurosurgical Unit, Es-Salud Trujillo Hospital, La Libertad, Peru; Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland; Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Danil A Kozyrev
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Neurosurgical Unit, Es-Salud Trujillo Hospital, La Libertad, Peru; Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Akitsugu Kawashima
- Neurosurgical Unit, Es-Salud Trujillo Hospital, La Libertad, Peru; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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Sajja A, Tsering D, Mooser AC, DeFreitas TA, Carpenter J, Magge SN. Patient With Severe Moyamoya Disease Who Presents With Acute Cortical Blindness. Stroke 2017; 48:e126-e129. [PMID: 28411258 DOI: 10.1161/strokeaha.116.015548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Aparna Sajja
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Deki Tsering
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Annie C Mooser
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Tiffani A DeFreitas
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Jessica Carpenter
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Suresh N Magge
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.).
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Abstract
Moyamoya disease is a rare cerebrovascular disease that causes occlusion of the supraclinoid internal carotid arteries and its branches within the Circle of Willis. While rare in the United States and Europe, moyamoya disease is much more common in eastern Asian populations. We present a 29 year-old Caucasian woman who initially presented with severe mental status changes and ataxia. MRI and MRA imaging, as well as pathologic examination at autopsy, revealed occlusion of the middle cerebral and anterior cerebral arteries bilaterally with associated infarctions. This case underscores the importance considering this diagnosis as an etiologic possibility during the workup of multiple infarcts, even in non-Asian populations.
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Rosenberg RE, Egan M, Rodgers S, Harter D, Burnside RD, Milla S, Pappas J. Complex chromosome rearrangement of 6p25.3->p23 and 12q24.32->qter in a child with moyamoya. Pediatrics 2013; 131:e1996-2001. [PMID: 23713105 DOI: 10.1542/peds.2012-0749] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 7-year-old white girl presented with left hemiparesis and ischemic stroke secondary to moyamoya syndrome, a progressive cerebrovascular occlusive disorder of uncertain but likely multifactorial etiology. Past medical history revealed hearing loss and developmental delay/intellectual disability. Routine karyotype demonstrated extra chromosomal material on 6p. Single nucleotide polymorphism microarray revealed a previously unreported complex de novo genetic rearrangement involving subtelomeric segments on chromosomes 6p and 12q. The duplicated/deleted regions included several known OMIM-annotated genes. This novel phenotype and genotype provides information about a possible association of genomic copy number variation and moyamoya syndrome. Dosage-sensitive genes in the deleted and duplicated segments may be involved in aberrant vascular proliferation. Our case also emphasizes the importance of comprehensive evaluation of both developmental delay and congenital anomalies such as moyamoya.
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Affiliation(s)
- Rebecca E Rosenberg
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA.
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Quality of life and psychological impact in adult patients with hemorrhagic moyamoya disease who received no surgical revascularization. J Neurol Sci 2013; 328:32-6. [DOI: 10.1016/j.jns.2013.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/22/2013] [Accepted: 02/13/2013] [Indexed: 11/19/2022]
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Su SH, Hai J, Zhang L, Yu F, Wu YF. Assessment of cognitive function in adult patients with hemorrhagic moyamoya disease who received no surgical revascularization. Eur J Neurol 2013; 20:1081-7. [PMID: 23577654 DOI: 10.1111/ene.12138] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 02/14/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Due to controversial surgical treatment for hemorrhagic moyamoya disease (MMD), a large proportion of these patients chose conservative treatment. The aim of this study was to assess cognitive function in adult patients with hemorrhagic MMD who received no surgical revascularization. METHODS Twenty-six adult hemorrhagic MMD patients with only intraventricular hemorrhage (IVH) confirmed by positive computed tomography and magnetic resonance imaging scan, 20 patients with spontaneous IVH whose digital subtraction angiography results were negative, and 30 healthy controls were identified and matched for age, gender, education background and living area. Cognitive function was evaluated by Montreal Cognitive Assessment (MoCA). The non-parametric test was used for comparisons among the three groups. RESULTS No patient was confirmed cognitive dysfunction at the initial screening. Twenty-four (92%) cases presented mild cognitive impairment (MCI) after 1 year. All the cases demonstrated MCI after 2 years. The difference between cases and healthy controls was statistically significant at the second screening (P = 0.000) and the third screening (P = 0.000), as was that between cases and patients with spontaneous IVH at the second screening (P = 0.000) and the third screening (P = 0.000). In addition, there were significant decreases in all MoCA subscores (P = 0.000) with special regards to delayed recall, visual space and executive function in cases compared with the other two groups. Moreover, significant differences were found in the subgroups of smoking (P = 0.021) and Suzuki angiographic classification of MMD (P = 0.030). CONCLUSIONS Cognitive impairment is a long-term complication for adult hemorrhagic MMD patients who underwent conservative treatment.
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Affiliation(s)
- S-H Su
- Department of Neurosurgery, Tongji Hospital, Tongji University, Shanghai, China
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