【作者】 宋平； 陈晓斌； 罗明； 丁伟； 李继强； 蔡强； 何主强； 王远； 黄从刚； 吴京雷； 段发亮；

【Author】 Song Ping;Chen Xiaobin;Luo Ming;Ding Wei;Li Jiqiang;Cai Qiang;Wang Yuan;Huang Conggang;Wu Jinglei;Duan Faliang;Department of Neurosurgery,Wuhan No.1 Hospital;Department of Neurosurgery,Renmin Hospital of Wuhan University;

【机构】 武汉市第一医院神经外科； 武汉大学人民医院神经外科；

【摘要】 目的探讨全脑CT灌注(CTP)在血管重建术治疗烟雾病中的应用价值。方法回顾分析20例烟雾病患者的临床资料,其中男性11例,女性7例,年龄29岁-73岁,平均53.5岁。所有病人均经颅脑多普勒超声检查或MRA筛选,头颈部CTA和(或)全脑血管造影(DSA)确诊,所有病人在全麻下进行了脑血管重建手术,本研究采用CTP获取患者手术前后脑血流量(CBF),脑血容量(CBV),平均通过时间(MTT),局部灌注达到峰值的时间(T TP)等血流动力学参数,并采用临床mRS (Modified Rankin Scale)评分对患者手术前后进行功能评估及随访。结果所有患者术后脑血流均有不同程度改善,临床症状改善包括四肢肌力改善,头晕头痛消失,语言障碍恢复,反应迟钝好转等,其中1例于术后第2天再发失语,再次手术后好转,2例发作癫痫,药物可控制,1例再出血保守治疗好转。术后16例获得随访1-24个月,有3例手术部位再狭窄,狭窄率小于40%,有2例发生癫痫,药物治疗后好转,其余11例无临床症状,无明显并发症,恢复良好。结论 CTP可从血流动力学参数方面早期、快速评估各血管区脑血流状态,可以有效指导烟雾病手术方式、评价手术后脑血流状态改变情况及病情随访,具有重要的临床应用价值。更多还原

【Abstract】 Objective To investigate the value of whole brain CT perfusion(CTP) in the treatment of moyamoya disease with revascularization.Methods Retrospective analysis of 20 cases of moyamoya disease clinical data,including 11 males and 7 females,aged 29 years-73 years,mean 53.5 years.All patients were confirmed by cranial Doppler ultrasound or MRA screening,head and neck CTA and/or whole brain angiography(DSA),and all patients underwent cerebral revascularization under general anesthesia.In this study,CTP was used to obtain CBF,CBV,MTT and TTP were measured before and after the operation.The mRS(Modified Rankin Scale) score was used to evaluate the function of the patients before and after surgery.Results All patients had different degrees of improvement of cerebral blood flow.The improvement of clinical symptoms included improvement of muscle strength of the extremities,disappearance of dizziness and headache,recovery of speech disorders,and slow response.Among them,1 patient developed aphasia aga in on the 2 nd postoperative day.After surgery improved,2 cases of epilepsy seizures,drugs can be controlled,1 case of rebleeding conservative treatment improved.After operation,16 cases were followed up for 1-24 months.Three cases had restenosis at the surg ical site,the stenosis rate was less than 40%,epilepsy occurred in 2 cases and improved after the drug treatment.The remaining 11 cases showed no clinical symptoms,no obvious complications and recovery good.Conclusions CTP can early and quickly evaluate the cerebral blood flow status in various vascular regions from the aspects of hemodynamic parameters,which can effectively guide the operation mode of moyamoya disease,evaluate the changes of cerebral blood flow state and follow-up after surgery,and has important clinical value.更多还原