Technical Nuances of Different Surgical Revascularisation Techniques Used in Moyamaoya Disease Treatment
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Priekšvēsture: Mojamoja slimība ir reta progresējoša cerebrovaskulāra slimība, kas skar iekšējās miega artērijas, izraisot stenooklūziju un angiogrāfijai raksturīgu patoloģiski paplašinātu tīklveida asinsvadu veidošanos. Ārstēšana galvenokārt ir ķirurģiska, izmantojot tiešas, netiešas vai kombinētas revaskularizācijas metodes, un ir ziņots par daudz dažādu pieeju efektivitāti. Pēdējos gados ir publicēti vairāki klīniski un angiogrāfiski pētījumi par rezultātiem, tāpēc atsevišķu procedūru tehniskās nianses ir aktuālas.
Mērķis: Šī darba mērķis ir pārskatīt angļu valodā pieejamo literatūru par Mojamoja slimības ķirurģisko ārstēšanu, kā arī aprakstīt un salīdzināt dažādu apvedceļošanas metožu tehniskās nianses.
Metodes: Tika veikta meklēšana PubMed datubāzē, izmantojot atslēgas vārdus "Moyamoya", "surgical treatment" un "revascularization", identificējot atbilstošus pārskata rakstus un gadījumu aprakstus/seriālus. Pēc tam tika izmantotas atsauces, lai atrastu pirmavotus, kuros visprecīzāk aprakstītas operācijas metodes. Tika aplūkotas šādas metodes: STA-MCA apvedceļš, STA-ACA apvedceļš, omentālā transplantācija (OT), daudzkārtēja urbuma caurumi (MBH), encefalo-arterio-sinangioze (EAS), encefalo-mio-sinangioze (EMS), encefalo-mioarterio-sinangioze (EMAS), encefalo-duroarterio-sinangioze (EDAS), encefalo-duro-arterio-mio-sinangioze (EDAMS), encefalo-duro-galeo (periostālā) sinangioze (EDGS), encefalo-temporoparietālā fasciālā lāpstiņa sinangioze (ETS), piāli perikraniālā durālā (PiPeD) revaskularizācija un dažādas kombinētas netiešās un tiešās procedūras.
Secinājumi: Ir pieejami ļoti dažādi ķirurģiskās revaskularizācijas paņēmieni, un diskusijas par to, kurš no tiem ir labāks, joprojām turpinās. Tiešās un kombinētās metodes ir tehniski sarežģītākas nekā netiešās pieejas, bet var nodrošināt labākus klīniskos rezultātus. Ir nepieciešami turpmāki pētījumi, ideālā gadījumā ietverot prospektīvus, daudzcentru randomizētus kontrolētus pētījumus, lai sniegtu ieteikumus, kas balstīti uz augsta līmeņa pierādījumiem par ideālu šīs slimības ārstēšanu.
Background: Moyamoya disease is a rare progressive cerebrovascular condition affecting the internal carotid arteries leading to steno-occlusion and the development of characteristic abnormally dilated net-like vessels on angiography. The treatment is primarily surgical with direct, indirect, or combined revascularization techniques and a large variety of approaches have been reported to be effective. In recent years several clinical and angiographic outcome studies have been published, making the technical nuances of individual procedures relevant. Objective: The aim of this work is to review the available English literature on the surgical treatment of Moyamoya disease and to describe and compare the technicalities of different bypass techniques. Methods: A search of the PubMed database using the keywords “Moyamoya”, “surgical treatment” and “revascularization” was conducted, identifying relevant review articles and case reports/series. The references where then used to find primary sources describing operative techniques in greatest detail. The reviewed techniques include STA-MCA bypass, STA-ACA bypass, omental transplantation (OT), multiple burr holes (MBH), encephalo-arterio-synangiosis (EAS), encephalo-myo-synangiosis (EMS), encephalo-myo-arterio-synangiosis (EMAS), encephalo-duro-arterio-synangiosis (EDAS), encephalo-duro-arterio-myo-synangiosis (EDAMS), encephalo-duro-galeo (periosteal)-synangiosis (EDGS), Encephalo-temporoparietal fascial flap-synangiosis (ETS), pial pericranial dural (PiPeD) revascularization and different combined indirect and direct procedures. Conclusion: A large variety of surgical revascularization techniques are available and the debate on which one is superior is still ongoing. Direct and combined techniques are technically more challenging than indirect approaches but may provide better clinical outcomes. Further research, ideally including prospective, multi-centre randomized controlled trials is necessary to make recommendations based on high level evidence about the ideal treatment of this disease.
Background: Moyamoya disease is a rare progressive cerebrovascular condition affecting the internal carotid arteries leading to steno-occlusion and the development of characteristic abnormally dilated net-like vessels on angiography. The treatment is primarily surgical with direct, indirect, or combined revascularization techniques and a large variety of approaches have been reported to be effective. In recent years several clinical and angiographic outcome studies have been published, making the technical nuances of individual procedures relevant. Objective: The aim of this work is to review the available English literature on the surgical treatment of Moyamoya disease and to describe and compare the technicalities of different bypass techniques. Methods: A search of the PubMed database using the keywords “Moyamoya”, “surgical treatment” and “revascularization” was conducted, identifying relevant review articles and case reports/series. The references where then used to find primary sources describing operative techniques in greatest detail. The reviewed techniques include STA-MCA bypass, STA-ACA bypass, omental transplantation (OT), multiple burr holes (MBH), encephalo-arterio-synangiosis (EAS), encephalo-myo-synangiosis (EMS), encephalo-myo-arterio-synangiosis (EMAS), encephalo-duro-arterio-synangiosis (EDAS), encephalo-duro-arterio-myo-synangiosis (EDAMS), encephalo-duro-galeo (periosteal)-synangiosis (EDGS), Encephalo-temporoparietal fascial flap-synangiosis (ETS), pial pericranial dural (PiPeD) revascularization and different combined indirect and direct procedures. Conclusion: A large variety of surgical revascularization techniques are available and the debate on which one is superior is still ongoing. Direct and combined techniques are technically more challenging than indirect approaches but may provide better clinical outcomes. Further research, ideally including prospective, multi-centre randomized controlled trials is necessary to make recommendations based on high level evidence about the ideal treatment of this disease.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Mojamoja, ķirurģiskās metodes, revaskularizācija, netiešais šuntējums, tiešais šuntējums, kombinētais šuntējums, STA-MCA, STA-ACA, 1D2R, 2D2R, MBH, EAS, EMS, EMAS, EDAS, EDAMS, EDGS, ETS, PiPeD., Moyamoya, surgical techniques, revascularization, indirect bypass, direct bypass, combined bypass, STA-MCA, STA-ACA, 1D2R, 2D2R, MBH, EAS, EMS, EMAS, EDAS, EDAMS, EDGS, ETS, PiPeD.