A flow self-regulating superficial temporal artery–middle cerebral artery bypass based on side-to-side anastomosis for adult patients with moyamoya disease

Abstract

OBJECTIVE Side-to-side (S-S) superficial temporal artery–middle cerebral artery (STA-MCA) bypass was reportedly used to treat a special moyamoya disease (MMD) patient with collaterals arising from the donor STA. However, the S-S technique is not routinely performed to date, and its benefits are still unknown for adult MMD. The purpose of this study was to investigate the possibility of routine use of the S-S technique for adult MMD. METHODS The authors retrospectively analyzed the clinical data of 50 adult patients (65 hemispheres, including 30 in the end-to-side [E-S] group and 35 in the S-S group) with MMD who underwent STA-MCA bypass. The patient demographic characteristics, clinical courses, technical details, intraoperative blood flow data, postoperative and preoperative relative cerebral blood flow (rCBF) values, modified Rankin Scale (mRS) scores, and short-term revascularization results were compared between the 2 groups. RESULTS There were no significant differences observed in terms of the baseline characteristics, bypass patency rates, postoperative/preoperative rCBF values, incidence of cerebral hyperperfusion syndrome (CHS), mRS scores, and short-term revascularization results between the 2 groups (all p > 0.05). Intraoperative blood flow analysis showed that the increase of STA flow in the E-S group was significantly higher than that of proximal STA flow in the S-S group (p = 0.008). Although the increases of proximal and distal recipient flow in the E-S group seemed greater than those in the S-S group, the results were not statistically significant (p = 0.086 for proximal flow and p = 0.076 for distal flow). CHS symptoms in the S-S group were milder and with much shorter duration. The follow-up angiographic data of the representative case demonstrated that both frontal and parietal STA branches and the occipital artery participated in postoperative collateralization. CONCLUSIONS S-S anastomosis can achieve comparable clinical effects to standard E-S construction. S-S anastomosis used in adult MMD demonstrated mild CHS symptoms with short duration and had the potential to arouse all scalp arteries as donor sources for revascularization through the intact distal STA branch via flow self-regulation.

Designing a flow-controlled STA-MCA anastomosis based on the Hagen–Poiseuille law for preventing postoperative hyperperfusion in adult moyamoya disease

“…In another research, we also introduced a flow self-regulating superficial temporal artery–middle cerebral artery bypass based on side-to-side anastomosis for adult patients with MMD, which may also reduce the incidence of CHP. 20 …”

Intraoperative evaluation of local cerebral hemodynamic change by laser speckle contrast imaging for predicting postoperative cerebral hyperperfusion during STA-MCA bypass in adult patients with moyamoya disease

“…The earlier 45 hemispheres underwent the conventional E-S bypass method, while the later 85 hemispheres underwent the novel side-to-side (S-S) bypass method. 27 The diagnosis of MMD in all patients was established using digital subtraction angiography (DSA). All patients satisfied the diagnostic criteria set by the Research Committee on Spontaneous Occlusion of the Circle of Willis of the Ministry of Health, Labour and Welfare, Japan.…”

Liquid chromatography coupled to mass spectrometry metabolomic analysis of cerebrospinal fluid revealed the metabolic characteristics of moyamoya disease

“…We recruited a total of 36 patients who had been diagnosed with MMD through cerebral angiography between January 2021 and June 2022 at Zhongnan Hospital of Wuhan University. All patients satisfied the diagnostic criteria of the Research Committee on Spontaneous Occlusion of the Circle of Willis of the Ministry of Health, Labor, and Welfare, Japan (13)(14)(15). Our study excluded MMD patients with comorbid conditions such as hypertension, diabetes, and coronary artery disease.…”