烟雾病合并颅内动脉瘤的疗效分析：单中心回顾性研究

An Investigative Study on the Complications of Moyamoya Disease Concurrent with Intracranial Aneurysm: A Retrospective Analysis from a Single-Center

摘要: 目的：烟雾病(MMD)合并动脉瘤患者的发病率低，但预后较差。本文采用单中心回顾性分析MMD合并动脉瘤患者的临床特征，分析影响患者动脉瘤破裂及术后预后的危险因素，为MMD合并动脉瘤患者的临床治疗提供参考依据。方法：本文回顾性分析了青岛大学附属医院神经外科2010年1月至2022年12月收治的MMD合并颅内动脉瘤的患者资料。经过单因素的秩和检验筛查，确定与MMD相关动脉瘤破裂及手术预后的危险因素。结果：在2010年至2022年期间，共有21例MMD合并颅内动脉瘤(24个动脉瘤)患者接受外科手术治疗。患者的最大年龄为77岁，最小年龄25岁，平均年龄56.43岁(标准差13.98岁，中位数为59岁)。包含11名男性和10名女性。单因素秩和检验分析结果：随着术后并发症的出现，患者术后预后完全治愈的概率显著降低，死亡率升高，术后出现并发症与预后的差异有统计学意义。患者年龄、性别、神志情况、术前蛛网膜下腔出血次数、术前Hunt-Hess分级、蛛网膜下腔出血的CT分型、动脉瘤的位置、侧别、大小，术中动脉瘤破裂情况，患者手术时机与预后的差异无统计学意义。结论：我们的研究结果表明术后出现并发症是影响MMD合并动脉瘤患者手术预后的危险因素。MMD相关颅内动脉瘤破裂的危险因素仍需进一步大型临床随机对照试验研究。

Abstract: OBJECTIVE: Patients with moyamoya disease (MMD) combined with aneurysm have a low incidence but poor prognosis. This paper adopts a single-center retrospective analysis of the clinical characteristics of patients with MMD combined with aneurysm, and analyzes the risk factors affecting the patients’ aneurysm rupture and postoperative prognosis, so as to provide a reference basis for the clinical treatment of patients with MMD combined with aneurysm. METHODS: This paper retrospectively analyzed the data of patients with MMD combined with intracranial aneurysm admitted to the Department of Neurosurgery of Affiliated Hospital of Qingdao University from January 2010 to December 2022. The risk factors for aneurysm rupture and surgical prognosis associated with MMD were identified after a one-way rank sum test screening. RESULTS: A total of 21 patients with MMD combined with intracranial aneurysms (24 aneurysms) underwent surgery between 2010 and 2022. The maximum age of the patients was 77 years, the minimum age was 25 years, and the mean age was 56.43 years (standard deviation 13.98 years, median 59 years). 11 males and 10 females were included. The results of one-way rank sum test analysis: with the emergence of postoperative complications, the probability of complete cure of the patients' postoperative prognosis decreased significantly, the mortality rate increased, and the difference between the emergence of postoperative complications and prognosis was statistically significant. There was no statistically significant difference between the timing of surgery and prognosis of patients with age, gender, mental status, number of preoperative subarachnoid hemorrhages, preoperative Hunt-Hess grading, CT staging of subarachnoid hemorrhage, location, side, and size of aneurysm, and rupture of aneurysm during surgery. CONCLUSION: Our findings suggest that postoperative complications are a risk factor for surgical prognosis in patients with MMD combined with aneurysms. The risk factors for rupture of MMD-associated intracranial aneurysms still need to be investigated in further large clinical randomized controlled trials.