CT perfusion assessment of Moyamoya syndrome before and after direct revascularization (superficial temporal artery to middle cerebral artery bypass)

Chen, Yue‐Qin; Xu, Wenjian; Guo, Xiang; Shi, Zhitao; Sun, Zhanguo; Gao, Lingyun; Jin, Feng; Wang, Jiehuan; Chen, Weijian; Yang, Yunjun

doi:10.1007/s00330-015-3802-4

Cited by 30 publications

(20 citation statements)

References 22 publications

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“…In addition, perfusion CT and MRI are alternative methods used to detect increased blood flow in anastomotic areas 47 , 48 . Some inspection methods also have certain significance in the prediction of HS.…”

Section: Hyperperfusion Syndrome (Hs)-induced Local Neurological Impamentioning

confidence: 99%

Progress on Complications of Direct Bypass for Moyamoya Disease

Shi

Guo

et al. 2016

Int. J. Med. Sci.

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Moyamoya disease (MMD) involves progressive occlusion of the intracranial internal carotid artery resulting in formation of moyamoya-like vessels at the base of the brain. It can be characterized by hemorrhage or ischemia. Direct vascular bypass is the main and most effective treatment of MMD. However, patients with MMD differ from those with normal cerebral vessels. MMD patients have unstable intracranial artery hemodynamics and a poor blood flow reserve; therefore, during the direct bypass of superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis, perioperative risk factors and anesthesia can affect the hemodynamics of these patients. When brain tissue cannot tolerate a high blood flow rate, it becomes prone to hyperperfusion syndrome, which leads to neurological function defects and can even cause intracranial hemorrhage in severe cases. The brain tissue is prone to infarction when hemodynamic equilibrium is affected. In addition, bypass vessels become susceptible to occlusion or atrophy when blood resistance increases. Even compression of the temporalis affects bypass vessels. Because the STA is used in MMD surgery, the scalp becomes ischemic and is likely to develop necrosis and infection. These complications of MMD surgery are difficult to manage and are not well understood. To date, no systematic studies of the complications that occur after direct bypass in MMD have been performed, and reported complications are hidden among various case studies; therefore, this paper presents a review and summary of the literature in PubMed on the complications of direct bypass in MMD.

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Section: Hyperperfusion Syndrome (Hs)-induced Local Neurological Impamentioning

confidence: 99%

Progress on Complications of Direct Bypass for Moyamoya Disease

Shi

Guo

et al. 2016

Int. J. Med. Sci.

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“…Previous studies suggested that in patients with MMD, the CBF and CBV significantly increased after surgical revascularization (24,(26)(27)(28). However, in previous studies, the patients included were mainly ischemic MMD, of which hemodynamic characteristics may be different from those of hemorrhagic MMD.…”

Section: Discussionmentioning

confidence: 96%

“…In addition, the selection of a reference ROI is very important. In most studies, contralateral mirroring areas has been selected as reference ROI, which is unreasonable because anterior cerebral arteries such as anterior cerebral artery (ACA) and middle cerebral artery (MCA) might be occluded or be occluding with the progress of moyamoya disease, and the CTP parameters may be also changing accordingly (24,26). In this study, we selected pons (basilar artery territory) as reference area manually, and found that in patients with hemorrhagic MMD, the CBF did not increase, and the CBV even decreased significantly after revascularization either in DBA or CMT, which was significantly different from previous studies.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Hemodynamic Changes After Revascularization in Patients With Hemorrhagic Moyamoya Disease

Kang

et al. 2020

Front. Neurol.

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Objective: To explore the cerebral hemodynamic changes after revascularization in patients with hemorrhagic moyamoya disease (MMD). Materials and Methods: We retrospectively included 57 hemorrhagic MMD patients in a high-volume stroke center from January 2016 to December 2018. All subjects were evaluated with whole-brain CT perfusion (CTP) before and after surgical revascularization. Absolute and relative CTP values in the regions of cortical middle cerebral artery territory (CMT) and deep brain area (DBA) of hemorrhagic hemispheres were measured. Differences between pre-and post-operative CTP values were assessed comprehensively. The patients were categorized into subgroups based on revascularization subtypes and postoperative CTP intervals. Results: The relative cerebral blood volume (rCBV) in DBA and CMT significantly reduced in postoperative CTP (P < 0.05). The median and interquartile range of the proportion of rCBV decrease (rCBVc%) were 7.2% (2.3-13.2%). The rCBV reduction retained statistical significant in patients who received subtypes of revascularization, and in patients with variable intervals of follow-up (P < 0.05). There was no significant difference of rCBVc% between patients who received different revascularization and among patients with different postoperative CTP intervals (P > 0.05). The relative mean transit time (rMTT) and relative time to peak (rTTP) also showed downward trends, but without retainable statistical significance in stratified analysis. There was no significant change in relative cerebral blood flow (rCBF) (P > 0.05). Conclusion: In patients with hemorrhagic MMD, the CBV appeared to decrease and be relatively stable in the chronic phase after revascularization, with varying degrees of MTT and TTP shortening. However, there was no significant change in CBF.

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“…Evidence also showed that unilateral revascularisation could increase CBF in the contralateral non-intervened hemisphere [9] . In one study, Chen et al demonstrated significantly improved CBF in less than 2 weeks after operation [10] . CTP was used in this study to provide a quantitative analysis of CBF before and after STA-MCA anastomosis [10] .…”

Section: Discussionmentioning

confidence: 97%

“…In one study, Chen et al demonstrated significantly improved CBF in less than 2 weeks after operation [10] . CTP was used in this study to provide a quantitative analysis of CBF before and after STA-MCA anastomosis [10] .…”

Section: Discussionmentioning

confidence: 97%