Objective To investigate the relationship between the cerebral cortical microvascular char-acteristics and the treatment outcome of encephalo-duro-arterio-synangiosis (EDAS) in patients with moy-amoya disease. Methods Seventy-seven patients with moyamoya disease (58 ischemic cases, 19 hemor-rhagic cases) with complete data were analyzed retrospectively. All the 77 patients underwent unilateral or bilateral EDAS. The cortical angiograms were collected during the operation. The improvement of the postop-erative clinical symptoms was followed up. The improvement of cerebral metabolism was evaluated by positron emission tomography ( PET) , and the postoperative revascularization was evaluated by digital substraction an-giography (DSA). The relationship between different cortical microvascular densities and clinical symptoms, cerebral metabolism improvement and vascular reconstruction were compared. Results ①The rate of the clinical symptom improvement was 66.2% in 77 patients. With the increased cortical microvascular density on both sides, the rate of the clinical symptom improvement was also increased (left hemisphere x2 =2.708, P >0.05, right hemisphere x2 =6.390, P <0.05). The Spearman rank correlation test showed that the left hemisphere was rs = -0.398 (P<0.01). The patients with high cortical microvascular density had a good clinical improvement. ②The good rate reached 60.4% in the postoperative assessment of cerebral metabo-lism. The cerebral metabolism improvement increased with the increased cortical microvascular density (x2= 5.493, P >0.05) ; in comparison with the left hemisphere it was x2 = 7.233 (P < 0. 05). The Spearman rank correlation test showed that the whole group was rs= -0.275 (P <0.05), in which the left hemisphere was rs =-0. 388 (P<0.01). ③In the postoperative revascularization assessment, the patients who reached grade≥2 was 70.5%. Compared to the different cortical microvascular density groups, there were statistically significant differences (x2 =30.252, P<0.01); The higher the cortical microvascular density, the higher the proportion of grade ≥2 revascularization. The Spearman rank correlation test showed that it was rs = 0.563 (P <0.01). Conclusion ED AS for treatment of patients with moyamoya disease can improve the symptoms of cerebral ischemia and neurological deficit, and increase in brain metabolism and cerebral perfusion. There is a grade correlation between the cortical microvascular density and the treatment outcome of EDAS.%目的 探讨烟雾病患者的皮质微血管特征与脑硬脑膜颞浅动脉血管融通术(EDAS)治疗效果间的关系. 方法 对77例资料完整的烟雾病患者进行回顾性分析.其中缺血型病例58例,出血型病例19例.77例患者均接受单侧或双侧EDAS,术中采集皮质血管照片,确定皮质微血管密度；术后随访患者临床症状的改善情况,并采用正电子发射断层显像(PET)评价脑代谢改善的程度,DSA评价术后血管重建情况(参照松岛分级).比较不同微血管密度与临床症状、脑代谢改善程度以及血管重建情况的关系. 结果 ①77例患者术后临床症状改善优良率为66.2％,双侧均随微血管密度的增加,临床症状改善的优良率也增加,其中左侧x2 =2.708.P＞0.05,右侧x2=6.390,P＜0.05.Spearman秩相关检验显示,左侧rs=-0.398,P＜0.01,密度高者临床改善程度良好.②术后脑代谢评估,优良率为60.4％,脑代谢改善程度随微血管密度增加而上升,x2 =5.493,P略大于0.05;左侧比较中,x2=7.233,P＜0.05.Spearman秩相关检验显示,全组rs=-0.275,P＜0.05;其中左侧rs=-0.388,P＜0.01.③术后血管重建评估中,≥Ⅱ级为70.5％,不同微血管密度组比较,差异有统计学意义,x2=30.252,P＜0.01;微血管密度越高,≥Ⅱ级的血管重建的比例就越高.Spearman秩相关检验显示,rs=0.563,P＜0.01. 结论 EDAS术治疗烟雾病患者能够改善脑缺血症状和神经功能缺损程度,增加脑代谢和灌注.皮质微血管密度与EDAS治疗效果间存在等级相关关系.
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