Clinical analysis of superficial temporal artery ⁃ middle cerebral artery bypass combined with temporoparietal fascia in the treatment of moyamoya disease

Abstract

Objective To investigate the efficacy and safety of superficial temporal artery (STA)⁃middle cerebral artery (MCA) bypass combined with temporoparietal fascia flap in the treatment of moyamoya disease (MMD). Methods Retrospective analysis was performed on 18 patients with MMD who were treated with STA⁃MCA bypass combined with temporoparietal fascia flap in Tianjin Huanhu Hospital from January 2018 to January 2020. The improvement of clinical symptoms, incision healing and complications were observed 7 days or 6 months after operation. DSA and PWI were used to evaluate the changes of cerebral hemodynamics, patency of bridge anastomosis and collateral compensation in pre⁃and post⁃operation. Results During the postoperative and follow⁃up period, 13 cases showed significant improvement in clinical symptoms, 4 cases showed no obvious improvement, one case was worse than before operation, 5 cases had cerebral hyperperfusion syndrome (CHS), one case had ischemic stroke, 2 cases had residual limb movement disadvantage, one case had unsteady walking, and one case had memory loss. All the patients had good wound healing during the postoperative and follow⁃up period. All operative incisions healed well, cerebral blood flow (CBF) and cerebral blood volume (CBV) were improved, mean treasnit time (MTT) and time to peak (TTP) were slightly delayed, and blood flow at the bridge anastomis was unobvious. Conclusions STA⁃MCA bypass combined temporoparietal fascia flap can effectively improve cerebral hemodynamics, increase blood flow in MCA blood supply area and intracranial cerebral perfusion, reduce the incidence of ischemic stroke, maintain the normal anatomical position and the function of the temporalis muscle, and improve postoperative comfort of patients.

doi：10.3969/j.issn.1672⁃6731.2022.05.007