Objective To summarize the diagnosis and endovascular treatment of middle cerebral artery (MCA) bifurcation aneurysm. Methods Between January 2010 and June 2011, 32 patients with MCA bifurcation aneurysm underwent endovascular treatment. There were 12 males and 20 females, aged 49.5 years on average (range, 35-81 years). All patients had sudden headache, 2 cases had disturbance of consciousness and hemi plegia, and 22 cases had a history ofhypertension. Before operation, 10 cases were classified as Hunt-Hess level I, 15 cases as level II, and 7 cases as level III; 24 cases were classified as Fisher level II and 8 cases as level III. The patients underwent coil embolization using single microcatheter in 16 cases, using double microcatheter in 7 cases, using balloon-assisted in 4 cases, using single stent in 4 cases, and using double stent in 1 case. Results The results of postoperative immediate digital subtraction angiography showed that 30 patients achieved dense embolization, and 2 patients using single microcatheter achieved approximated dense embolization. Among them, 18 cases suffered extensive subarachnoid hemorrhage, thus lumbar puncture continued drainage was performed for 3-7 days; the other 14 cases had l ittle subarachnoid hemorrhage, lumbar puncture released hemorrhagic cerebrospinal fluid discontinuously, and after1 week, head CT demonstrated that subarachnoid hemorrhage was significantly decreased. At 1 day after surgery, 2 patients had local cerebral ischemia; after Nimotop and other drugs were used for 1 week, the symptom was alleviative. All 32 patients were followed up 4 to 17 months. No aneurysm rupture and bleed occurred during follow-up; no other complications or sequelae was observed except for 3 cases of hemiparesis and 1 case of aphasia. The computed tomographic angiography examination showed no re-open of dense embolized aneurysm at 3, 6 months, and 1 year after surgery. Conclusion As long as appropriate intervention treatment method is chosen, endovascular treatment of MCA bifurcation aneurysm is safe and effective.
Objective To compare the therapeutic effect of one-stage direct revascularization and medicine therapy for the treatment of ischemic moyamoya disease. Methods From March 2002 to March 2008, 18 patients with ischemic moyamoyadisease (12 males and 6 females) were treated, aged 9 to 33 years old. Eighteen patients presented with ischemic stroke, including 11 cases of cerebral infarction and 7 cases of transient ischemic attack. According to Chinese ischemic cardiovascular diseases evaluation tools, 17 patients were classified as low risk ischemic stroke and 1 as modernte risk ischemic stroke. Different levels of occlusion branch of the intracranial carotid arteries and pathosis collaterals were identified by DSA. Fourteen patients and 4 patients were showed unilateral and bilateral hypoperfusion of cerebral blood flow by single photon emission computed tomography, respectively. Eleven patients received superficial temporal artery-middle cerebral artery anastomosis and 7 patients received medicine (anti-PLT agglutinin and calcium channel blocker). Results All incisions healed at stage I. There was no stroke events during perioperation. Anastomosis vessel vasospasm occurred in 2 patients 5 days after operation; and hyperperfusion syndrome in 1 patient 2 weeks afteroperation. All patients were followed up 13-32 months (mean 18 months). In 11 anastomosis patients, 6 underwent 6 stroke events within 12 months; in 7 medicine patients, 6 underwent 11 stroke events within 12 months; and showing a significant difference (P lt; 0.05). The stroke recurrence rate was 85.7% in medicine patients and 54.5% in anastomosis patients 12 months after therapy. DSA showed pathosis collaterals in 7 anastomosis patients and 6 medicine patients 6 months after therapy. After 12 months according to modified Rankin scale, the scores of anastomosis patients were 3 points in 1 case, 2 points in 6 cases and 0-1 point in 4 cases, and the scores of medicine patients were 2 points in 2 cases and 0-1 point in 5 cases; showing no significant difference (P gt; 0.05). Conclusion As long as onset of stroke occurred and ischemic moyamoya disease is diagnosed, one-stage direct revascularization should be performed, which can reduce the rate of stroke recurrence risk and slow down the progression of disease.
Superficial temporal artery (STA) - middle cerebral artery (MCA) bypass surgery has been widely used to treat patients with moyamoya disease, and its application value in symptomatic internal carotid artery (ICA)/MCA stenosis/occlusion remains controversial. With the development of imaging, micro-devices and surgical techniques, and the deepen understanding of diseases, the effectiveness of STA-MCA bypass surgery in the treatment of symptomatic ICA/MCA stenosis/occlusion is further required. This article reviews the process of development and evolution of this surgical technique, as well as the significance and deficiencies of several randomized controlled trials of ICA/MCA treatment in the past, and looks forward to possible improvements in future research, so as to clarify the way for further randomized controlled study.