摘要：

目的: 探讨颞浅动脉（STA）-大脑中动脉（MCA）搭桥术联合脑-硬膜-颞肌-骨膜瓣贴敷术（EDMPS）治疗学龄前（≤ 6岁）儿童烟雾病的安全性及可行性。方法: 纳入2017年1月至2019年12月在航空总医院行STA-MCA搭桥术+ EDMPS的18例学龄前儿童烟雾病患儿，术后1周复查三维重建CTA及CT灌注成像评估开颅范围、桥血管通畅及缺血脑组织灌注改善，术后6个月复查CT或MRI观察有无新发脑梗死或脑出血，术后12个月复查CTA或DSA评估桥血管通畅情况，随访结束时采用改良Rankin量表（mRS）评估神经功能改善情况。结果: 共18例（31侧）患儿均顺利完成手术。术后1周复查CTA显示桥血管通畅；1例（例9）复查MRI提示无症状小面积梗死灶；4例术前存在短暂性脑缺血发作患儿术后症状消失；仅1例（例3）新发短暂性脑缺血发作。1例（例17）首次术后等待对侧手术期间（首次术后3 ~ 6个月）出现右侧新发脑梗死。平均随访（57.28 ± 13.32）个月，术后6个月无新发脑梗死或脑出血；术后12个月复查CTA或DSA，26侧桥血管通畅、5侧桥血管不显影，所有患儿均可见血管间接吻合形成的侧支代偿。至随访结束时中位mRS评分1.00（0.25，1.75）分。所有患儿均无缺血性或出血性卒中事件、脑过度灌注综合征、短暂性脑缺血发作、癫痫发作、认知功能障碍或切口愈合不良现象。结论: STA-MCA搭桥术+ EDMPS治疗学龄前儿童烟雾病既可快速改善缺血脑组织血供，也可实现较大范围的间接血运重建，安全性好且可行性高，长期随访疗效较好。

关键词: 脑底异常血管网病, 脑血管重建术, 颞动脉, 大脑中动脉, 儿童，学龄前

Abstract:

Objective: To explore the safety and feasibility of superficial temporal artery (STA)-middle cerebral artery (MCA) bypass combined encepho-dural-myo-pericranio-synangiosis (EDMPS) in the treatment of moyamoya disease (MMD) in preschool children (≤ 6 years old). Methods: The clinical data of 18 preschool children with MMD treated with STA-MCA + EDMPS surgery at Aviation General Hospital from January 2017 to December 2019 were analyzed. Postoperative one week CTA 3D reconstruction and CT perfusion (CTP) were performed to evaluate the scope of craniotomy, the patency of bypass vessels and improvement of ischemic cerebral tissue perfusion. Postoperative 6 months CT or MRI was performed to evaluate the new ischemic stroke or intracerebral hemorrhage, and CTA or DSA was performed 12 months after the operation to evaluate the patency of bypass vessels. The modified Rankin Scale (mRS) was used to evaluate the patients' neurological recovery. Results: The surgeries on 31 hemispheres of 18 patients were successfully completed. Postoperative one week CTA showed that the bypass vessel was unobstructed. Postoperative one week MRI of one case (Case 9) showed asymptomatic small-area cerebral infarction. All 4 patients who had transient ishchemic attack (TIA) symptoms before surgery had their symptoms disappear after surgery. Only one case (Case 3) developed TIA. One case (Case 17) developed contralateral new ischemic stroke while waiting for contralateral surgery after the first postoperative operation (3-6 months). The follow - up time of 18 patients was (57.28 ± 13.32) months. The new ischemic stroke or intracerebral hemorrhage was no observed in postoperative 6 months. Postoperative 12 months CTA or DSA showed that the STA -MCA bypass unobstructed in 26 sides of 13 patients and not visualized in 5 sides of 5 patients. Collateral vessels due to indirect revascularization were visible in all 18 patients. By the end of the follow-up, the median mRS score was 1.00 (0.25, 1.75). None of the children patients presented with ischemic or hemorrhagic stroke events, cerebral hyperperfusion syndrome (CHS), TIA, epileptic seizure, cognitive dysfunction or poor incision healing. Conclusions: Using STA-MCA + EDMPS to treat preschool children with MMD can not only quickly improve the blood supply of ischemic brain tissue, but also achieve a larger range of indirect revascularization. It is safe and feasible, and has good long-term follow-up results.

Key words: Moyamoya disease, Cerebral revascularization, Temporal arteries, Middle cerebral artery, Child, preschool