Therapeutic effect of multiple burr hole operation combined with dural inversion and periosteal synangiosis for moyamoya disease.
OBJECTIVE
To explore the therapeutic effect of multiple burr hole operation combined with dural inversion and periosteal synangiosis for moyamoya disease (MMD).


METHODS
We used a modified multiple burr hole operation, combined with dural inversion and periosteal synangiosis, in a series of 57 patients with ischemic-type MMD as a sole revascularization procedure. Postoperatively these patients were followed up for 6 months to 3 years.


RESULTS
The postoperative clinical outcomes were excellent for 24 patients (42.1%), good for 21 patients (36.8%), fair for 9 patients (15.8%), and poor for 3 patients (5.3%). There was a significant difference between the preoperative and postoperative modified Rankin Scale or mRS scores. The postoperative angiography revealed that there was sufficient neovascularization at 151 of the 160 burr holes. Effective neovascularization was not found at 9 burr holes in 4 patients. The neovascularization derived mainly from the superficial temporal artery and middle meningeal artery, and less from the posterior auricular artery, occipital artery, and deep temporal artery. The postoperative complications included one case of subdural hematoma, one case of subdural effusions, and five cases of postoperative temporary neurological deficits.


CONCLUSIONS
The multiple burr-hole operation combined with dural inversion and periosteal synangiosis is a simple, safe, and effective treatment for ischemic-type MMD as a sole treatment without supplementary revascularization procedures.
a Department of Neurosurgery , The Second Hospital of Shandong University , Jinan, Shandong Province , China.
Xu
X
Zhao
a Department of Neurosurgery , The Second Hospital of Shandong University , Jinan, Shandong Province , China.
Chengwei
C
Wang
a Department of Neurosurgery , The Second Hospital of Shandong University , Jinan, Shandong Province , China.
Yong
Y
Ji
a Department of Neurosurgery , The Second Hospital of Shandong University , Jinan, Shandong Province , China.
Chao
C
Han
a Department of Neurosurgery , The Second Hospital of Shandong University , Jinan, Shandong Province , China.
Minqing
M
Wang
D000293:Adolescent; D000328:Adult; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000254:growth & development; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000379:methods; D002648:Child; D004388:Dura Mater / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000601:surgery*; D018919:Neovascularization, Physiologic; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D014207:Trephining / Q000379:methods*; D055815:Young Adult
dural inversion; indirect revascularization; moyamoya disease; multiple burr hole operation