学术动态 | 中南病院神经外科在Nature子刊报说念烟雾病侧侧吻合能更好期骗头皮动脉已毕平直血运重建

学术动态神外前沿 255期

神外前沿讯，12月2日，武汉大学中南病院神经外科陈劲草矜重（专访贯穿）、章剑剑矜重（专访贯穿）团队在 Nature子刊-Scientific Reports（影响因子4.6，JCR分区Q1）上报说念了侧侧搭桥新术式怎么更好地改善烟雾病患者的血运重建。

磋议发现，侧侧吻合时代能有用期骗头皮动脉(scalp arteries)，尤其是颞浅动脉额支和枕动脉，通过保留的颞浅动脉远端在成年烟雾病患者中已毕平直血运重建。头皮动脉可手脚供体动脉的补充起首，关于血运重建根除欠佳的患者尤其成心。

论文信息

Role of scalp arteries in revascularization after side to side anastomosis in moyamoya disease patients

https://www.nature.com/articles/s41598-024-81362-6

据了解，由于烟雾病平直吻捏术后血流能源学变化复杂，患者可能会出现一系列术后并发症，比如复发性缺血、出血、明白功能减退、分水岭移位以及术后脑过度介意空洞征（CHS）等情况。

为了减少术后并发症并训诫吻捏术的安全性，武汉大学中南病院神经外科团队于2022年独创了侧侧吻合吻合术。

磋议者发现袭取侧侧手术的患者脑过度介意空洞征症状更轻且接续时刻更短。更为遑急的是，磋议者觉得侧侧手术具备促进血流自我颐养的后劲，能窜改头皮动脉手脚供体起首，并通过颞浅动脉的远端分支已毕平直血运重建。

在本次磋议中，通过更永劫刻的随访，磋议者初次报说念了在侧侧手术后，头皮动脉可通过保留的颞浅动脉远端参与平直血运重建。

在这项磋议中，磋议者招募了袭取侧侧或端侧吻合的烟雾病患者，集聚并对比了临床数据和血管造影参数。共纳入了44例袭取端侧吻合以及40例袭取侧侧吻合的烟雾病患者。

两组患者的基本特征以及术后Matsushima分级并无权臣互异。不外，侧侧吻合组等分级为D级的患者比例（0%）低于端侧吻合组（11.4%，P = 0.028）。

与端侧吻合组比拟，侧侧吻合组袒露枕动脉（OA）在血运重建中的参与度更高（87.5%对56.8%，P = 0.002），况兼颞浅动脉（STA）额支术后管径变化率（CCR）也更高（1.26 ± 0.43对1.04 ± 0.53，P = 0.038）。

这种互异在血运重建根除欠安的亚组中更为权臣：在侧侧吻合组中，颞浅动脉额支的管径变化率和血运重建参与进度辩别为1.163 ± 0.168和58.8%，而在端侧吻合组中，这两容貌标仅辩别为0.798 ± 0.494和6.7%。与端侧吻合组（辩别为0.941 ± 0.216和37.5%）比拟，侧侧吻合组的枕动脉管径变化率（1.133 ± 0.257）和参与度（82.4%）也更高。

Distributions of postoperative Matsushima grades in groups with different anastomosis procedure. Aintraoperative microscopic photographs showed the side-to-side (S-S) anastomosis between superficial temporal artery (STA) and the recipient artery (RA). The lower left panel showed the anastomosis after completion, and the lower right panel showed the indocyanine green fluorescence angiography corresponding to the surgical field, which showed the patency of the bypass. The dotted circle indicates the anastomosis site; B the bar chart showed the distribution of each postoperative Matsushima grades in end-to-side (E-S) group and S-S group, and the two groups have obvious differences in Matsushima grade D (P < 0.05); C, Illustrations of postoperative Matsushima grades A-C in the S-S group, and Matsushima grade D from E-S group. Red arrows showed the course of STA parietal branch, blue arrows indicated the RA, white dotted irregular rings inferred the areas of postoperative revascularization. DSA, digital subtraction angiography.

Illustrations of external carotid artery (ECA) branches involved in direct revascularization after side-side (S-S) bypasses. A preoperative digital subtraction angiography (DSA) from patient 1 showed the superficial temporal artery (STA) parietal (red arrows) and frontal (yellow arrows) branches, there was no obvious anastomosis between the two arteries. After S-S bypass, the DSA at postoperative 3 months showed the enlarged STA frontal branch (yellow thick arrows) contributed in the postoperative revascularization through the reserved distal end of STA parietal branch. Red dotted circle indicted the anastomosis site, blue arrow head indicated the filling of recipient artery, white dotted ring indicated the revascularization area; B, patient 2’s DSA showed obviously preoperative spontaneous anastomosis (white arrows) between the STA parietal branch (red arrows) and the occipital artery (OA) (green arrows) in scalp. 5 months after the S-S bypass (red dotted circle indicted the anastomosis site), the OA was enlarged and participated in postoperative revascularization via the reserved distal end of STA parietal branch, and archived moderate effect (green dotted oval). Blue arrow head indicated the filling of recipient artery; C, preoperative DSA from patient 3 showed no connection between the STA (red arrow) and OA (green arrow). 6 months after S-S bypass, spontaneous anastomoses (white arrows) were formed between the OA and distal donor STA, thus let OA flow entered the intracranial (white dotted oval); D, DSA at postoperative 12 months from patient 4 illustrated the co-participating of OA (green arrows) and STA frontal branch (yellow arrows) in postoperative revascularization (white dotted oval), although the STA parietal branch (red arrow) seemed weak even before surgery, the OA and STA frontal branch played the backup roles to direct revascularization and avoided the occurrence of complete no revascularization effect.

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