老年学と老年医学の研究

概要

Complication Incidence and Management of Adult and Pediatric Moyamoya Disease after Bypass Surgeries

Zhang Q, Feng R, Zhang X, Jiang H, Zhu Y, Yingying G, Xu C, Yuxiang G and Yibing S

Background: Multiple literatures have shown that extra-intracranial vascular direct bypass provides good outcome for patients diagnosed as moyamoya disease (MMD), but complications occurred frequently after surgeries. This study aims to discuss the postoperative complications, occurrence rate and postoperative management of MMD patients who underwent surgeries.

Materials and Methods: We retrospectively collected data of consecutive patients diagnosed with MMD and then underwent combination surgery of direct bypass and EDMS in our department between Jan 2013 to Dec 2015. Postoperative complications include acute brain infarction, intracranial bleeding and CHS. All patients were strictly monitored to avoid hypovolemia, low blood pressure and anemia after surgeries. Edaravone was the main medicine used for postoperative treatment.

Results: Totally 368 consecutive patients (408 hemispheres) are included. The most frequent complication was CHS-related neurological deficits which were observed in 73 patients (19.8%). The most frequently occurred deficits was aphasia (88.5%). There were more left sided surgeries in the CHS plus brain infarction group (76.9% vs. 49.7%, p<0.05). Furthermore, CHS and brain infaction seemed to occur more frequently in adult patients (21.3%) when compared to pediatric patients (16.7%), but not significantly (p>0.05).

Discussion: Incidence of CHS is higher in left lateralization surgeries than right lateralization, and aphasia is the most frequent CHS symptom. Adult patients seem at higher risk for postoperative hyper-perfusion than pediatric patients, but not statistically significant in our study. It is important to observe CHS correctly and timely for neurosurgical nurses, in order to manage it properly.