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Yoshioka H, Wakai T, Hashimoto K, Tateoka T, Fukuda N, Horiuchi R, Umeda T, Onishi H, Kinouchi H. Iodine-123-Iomazenil Single-Photon Emission Computed Tomography Revealed Recovery of Neuronal Viability in Association With Improvement of Cognitive Dysfunction After Revascularization in Moyamoya Disease. Neurosurgery 2024:00006123-990000000-01296. [PMID: 39041800 DOI: 10.1227/neu.0000000000003127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Recent studies indicate that 123I-iomazenil (123I-IMZ) single-photon emission computed tomography (SPECT) can demonstrate neuronal viability. Although cognitive dysfunction has been recognized as an important issue in adult patients with moyamoya disease (MMD), no standard neuroradiological methods to define such conditions have been established. We examined the relationship between cognitive function and 123I-IMZ SPECT before and after revascularization in patients with MMD. METHODS The study participants were 16 adult patients with MMD whose cerebrovascular reactivities were decreased only on the surgical sides of combined revascularization. Cognitive function was examined using the Mini-Mental State Examination (MMSE; cutoff: 27) and the Frontal Assessment Battery (FAB; cutoff: 16) before and at 3 to 6 months after surgery. 123I-iodoamphetamine (123I-IMP) SPECT with acetazolamide challenge and 123I-IMZ SPECT were performed concurrently while evaluating cognitive function. The radioreactivities of 123I-IMZ SPECT in regions with decreased cerebrovascular reactivities on 123I-IMP SPECT were investigated using affected-to-contralateral side asymmetry ratio (IMZ-ACR). RESULTS Twelve patients showed normal cognitive function (MMSE: 29.8 ± 0.4, FAB: 18 ± 0) before surgery. No evident laterality of 123I-IMZ uptake was seen (IMZ-ACR: 0.98 ± 0.04). Neither cognitive function nor 123I-IMZ SPECT worsened after surgery (MMSE: 29.8 ± 0.3, FAB: 18 ± 0, IMZ-ACR: 1.00 ± 0.04). By contrast, 4 patients presented cognitive dysfunction (MMSE: 24.3 ± 3.9, FAB: 14.8 ± 2.7) before revascularization. Preoperative imaging of these patients showed decreased 123I-IMZ uptake, and their IMZ-ACRs (0.83 ± 0.08) were significantly lower than those of the normal group. After revascularization, cognitive functions and 123I-IMZ uptake tended to ameliorate (MMSE: 27.5 ± 1.7, FAB: 16.3 ± 2.2, IMZ-ACR: 0.94 ± 0.09). CONCLUSION Preoperative cognitive function was associated with 123I-IMZ uptake in adult patients with MMD. After revascularization, cognitive function could be recovered in the viable areas of the brain, which is consistent with 123I-IMZ SPECT findings.
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Affiliation(s)
- Hideyuki Yoshioka
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Takuma Wakai
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Koji Hashimoto
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Toru Tateoka
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Norito Fukuda
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Ryo Horiuchi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Takako Umeda
- Department of Radiology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Hiroshi Onishi
- Department of Radiology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan
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Yingqian H, Dan W, Liping L, Zhiman L, Dingxiang X, Zhuhao L, Zhiyun Y, Li J, Jing Z. Longitudinal evaluation of cerebral perfusion evolution after revascularization surgery in moyamoya disease by CT perfusion. J Stroke Cerebrovasc Dis 2024; 33:107638. [PMID: 38360250 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To assess the longitudinal evolution of cerebral perfusion after revascularization surgery in patients with moyamoya disease (MMD) by CT perfusion (CTP). MATERIALS AND METHODS Thirty-one clinically confirmed MMD patients (12 males and 19 females, average age: 33.26 y, Suzuki stages 3 and 4: 19 and 11, respectively) who underwent revascularization surgery (bilateral (n=13) or unilateral (n=18)) were studied retrospectively. All patients underwent CTP examinations before and in the week after surgery and long-term (>3 months). CTP metrics (CBF, CBV, MTT, TTP, and delay TTP) were derived. The corresponding CTP metric values of the ROIs, which were manually drawn in the white matter (WM) and gray matter (GM), were recorded. RESULTS Six patients developed a new or progressive cerebral infarction/hemorrhage. In all patients, compared with the preoperative level, the TTP of GM and WM decreased in the short term after the surgery (P ≤ 0.005). Concurrently, the WM CBF increased significantly a week after surgery (P =0.02). However, in the long-term follow-up, the CBV and CBF in the GM and WM decreased to equal to or lower than the preoperative level, especially for CBV in the WM (P =0.012). Furthermore, cerebral perfusion began to decrease in the sixth month, and a continuous decline was observed over the next two months. It returned to the presurgical level after one year. In addition, the improvement in postsurgical perfusion was greater in Suzuki stage 3 patients than stage 4 patients. CONCLUSION Cerebral perfusion in patients with MMD improved shortly after surgery. However, in the long-term, brain perfusion decreased, most seriously in 6-8 months postoperatively, which might indicate that patients with MMD need timely follow-up and long-term intervention.
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Affiliation(s)
- Huang Yingqian
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China
| | - Wei Dan
- Department of Radiology, Hui Ya Hospital of The First Affiliated Hospital, Sun Yat-sen University, Huizhou, 516000, PR China
| | - Lin Liping
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China
| | - Lai Zhiman
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China
| | - Xie Dingxiang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China
| | - Li Zhuhao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China
| | - Yang Zhiyun
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China
| | - Jiang Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China.
| | - Zhao Jing
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, Guangdong 510080, China.
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Development of cortical microvascularization in Moyamoya disease using the maximum intensity projection method from three-dimensional rotational angiography. Acta Neurochir (Wien) 2023; 165:605-611. [PMID: 36795224 DOI: 10.1007/s00701-023-05527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Neurosurgeons often experience increased cortical microvascularization in Moyamoya disease (MMD). However, there are no previous reports that radiologically evaluated preoperative cortical microvascularization. We investigated the development of cortical microvascularization and clinical characteristics of MMD using the maximum intensity projection (MIP) method. METHODS We enrolled 64 patients at our institution, including patients with MMD (n = 26), intracranial atherosclerotic disease (ICAD; n = 18), and unruptured cerebral aneurysms (n = 20) as the control group. All patients underwent three-dimensional rotational angiography (3D-RA). The 3D-RA images were reconstructed using partial MIP images. Cortical microvascularization was defined as the vessels that branched off from the cerebral arteries and were classified as grade 0-2 depending on their development. RESULTS Cortical microvascularization observed in patients with MMD was classified into grade 0 (n = 4, 8.9%), grade 1 (n = 17, 37.8%), and grade 2 (n = 24, 53.3%). The development of cortical microvascularization was more common in the MMD group than in the other groups. The inter-rater reliability measured using weighted kappa was 0.68 (95% confidence interval = 0.56-0.80). There were no significant differences in cortical microvascularization according to the onset type and hemispheres. Cortical microvascularization correlated with periventricular anastomosis. Most patients with Suzuki classifications 2-5 developed cortical microvascularization. CONCLUSION Cortical microvascularization was characteristic of patients with MMD. These findings developed in the early stages of MMD and may act as a bridge to the development of periventricular anastomosis.
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Neuroimaging in Moyamoya angiopathy: Updated review. Clin Neurol Neurosurg 2022; 222:107471. [DOI: 10.1016/j.clineuro.2022.107471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022]
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Choi EJ, Westmacott R, Kirkham FJ, Robertson A, Muthusami P, Shroff M, Moharir M, Williams T, Dirks P, MacGregor D, Slim M, Pulcine E, Bhathal I, Kaseka ML, Kassner A, Logan W, deVeber G, Dlamini N. Fronto-Parietal and White Matter Haemodynamics Predict Cognitive Outcome in Children with Moyamoya Independent of Stroke. Transl Stroke Res 2022; 13:757-773. [PMID: 35338434 DOI: 10.1007/s12975-022-01003-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
Moyamoya disease is a major arteriopathy characterised by progressive steno-occlusion of the arteries of the circle of Willis. Studies in adults with moyamoya suggest an association between abnormal fronto-parietal and white matter regional haemodynamics and cognitive impairments, even in the absence of focal infarction. However, these associations have not been investigated in children with moyamoya. We examined the relationship between regional haemodynamics and ratings of intellectual ability and executive function, using hypercapnic challenge blood oxygen level-dependent magnetic resonance imaging of cerebrovascular reactivity in a consecutive cohort of children with confirmed moyamoya. Thirty children were included in the final analysis (mean age: 12.55 ± 3.03 years, 17 females, 15 idiopathic moyamoya and 15 syndromic moyamoya). Frontal haemodynamics were abnormal in all regardless of stroke history and comorbidity, but occipital lobe haemodynamics were also abnormal in children with syndromic moyamoya. Executive function deficits were noted in both idiopathic and syndromic moyamoya, whereas intellectual ability was impaired in syndromic moyamoya, even in the absence of stroke. Analysis of the relative effect of regional abnormal haemodynamics on cognitive outcomes demonstrated that executive dysfunction was predominantly explained by right parietal and white matter haemodynamics independent of stroke and comorbidity, while posterior circulation haemodynamics predicted intellectual ability. These results suggest that parietal and posterior haemodynamics play a compensatory role in overcoming frontal vulnerability and cognitive impairment.
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Affiliation(s)
- Eun Jung Choi
- Neurosciences and Mental Health Program, Stroke Imaging Laboratory for Children, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Westmacott
- Department of Neuropsychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Fenella J Kirkham
- Developmental Neurosciences and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Amanda Robertson
- Neurosciences and Mental Health Program, Stroke Imaging Laboratory for Children, The Hospital for Sick Children, Toronto, ON, Canada
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Prakash Muthusami
- Diagnostic Imaging, The Hospital for Sick Children, ON, Toronto, Canada
- Medical Imaging, University of Toronto, ON, Toronto, Canada
| | - Manohar Shroff
- Diagnostic Imaging, The Hospital for Sick Children, ON, Toronto, Canada
- Medical Imaging, University of Toronto, ON, Toronto, Canada
| | - Mahendranath Moharir
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tricia Williams
- Department of Neuropsychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Dirks
- Department of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Daune MacGregor
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mahmoud Slim
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Pulcine
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ishvinder Bhathal
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Matsanga Leyila Kaseka
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea Kassner
- Medical Imaging, University of Toronto, ON, Toronto, Canada
- Department of Translational Medicine, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, ON, Toronto, Canada
| | - William Logan
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gabrielle deVeber
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Nomazulu Dlamini
- Neurosciences and Mental Health Program, Stroke Imaging Laboratory for Children, The Hospital for Sick Children, Toronto, ON, Canada.
- Stroke Program, Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada.
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Chen JY, Tu XK. Research Progress on Postoperative Transient Neurological Dysfunction in Pediatric and Adult Patients with Moyamoya Disease after Revascularization Surgery. Clin Neurol Neurosurg 2022; 217:107254. [DOI: 10.1016/j.clineuro.2022.107254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/01/2022] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
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Ueda Y, Tanaka Y, Hara S, Inaji M, Ishii K, Maehara T, Nariai T. Differences in cerebral blood flow measurement using arterial spin labeling MRI between patients with moyamoya disease and patients with arteriosclerotic cerebrovascular disease. Acta Radiol 2022; 64:311-319. [PMID: 35037475 DOI: 10.1177/02841851211069245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is unclear whether the accuracy of arterial spin labeling (ASL) magnetic resonance imaging (MRI) is the same between moyamoya disease (MMD), which is known to have markedly elevated cerebral blood volume (CBV), and atherosclerotic intracranial arterial stenosis (AS), which has relatively less elevated CBV. PURPOSE To investigate how the differences in hemodynamics affect measurement of ASL-cerebral blood flow (CBF) using ASL for patients with MMD and AS. MATERIAL AND METHODS Fourteen MMD and ten AS patients were evaluated with ASL-MRI, magnetic resonance angiography (MRA), and 15O-gas positron emission computed tomography (PET). The regional CBF values of ASL using two post-labeling delays (PLDs; 1525 ms and 2525 ms) were compared with the PET-derived CBF, CBV, and mean transit time (MTT). Corresponding anterior circulation results were evaluated by flow territory map-based analysis. RESULTS The correlation between the ASL-CBF values (2525 ms) and PET-CBF declined in the MMD group (r = 0.28; P < 0.01), while the AS group showed good correlation (r = 0.77; P < 0.01). In the MMD group, the ASL-CBF values (2525 ms) overestimated the PET-CBF values as the regional CBV values increased (r = 0.35; P < 0.01). When the regions of interest were divided into two subgroups according to the degree of arterial stenosis by MRA, the correlation coefficient between the ASL-CBF (2525 ms) and PET-CBF values improved (mild stenosis: r = 0.36; P = 0.06; severe stenosis: r = 0.51; P < 0.01). CONCLUSION The accuracy of CBF measurements using ASL-MRI differed between patients with MMD and AS. The prominent increase of CBV and the degree of arterial stenosis may have affected the accuracy of ASL-CBF in patients with MMD.
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Affiliation(s)
- Yasuhiro Ueda
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kenji Ishii
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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Wu H, Xia C, Li R, Tao C, Tang Q, Hu W. Correlation Between Apelin and Collateral Circulation in Patients with Middle Cerebral Artery Occlusion and Moyamoya Disease. Int J Gen Med 2022; 15:699-709. [PMID: 35082519 PMCID: PMC8784270 DOI: 10.2147/ijgm.s341015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/14/2021] [Indexed: 01/12/2023] Open
Abstract
Background and Objectives Moyamoya disease (MMD) is a unique cerebrovascular occlusive disease with abnormal vascular hyperplasia, which causes cerebrovascular accidents like intracranial arteriosclerosis. This study aimed to explore whether plasma apelin levels are related to good collateral circulation in ischemic diseases, which may be higher in patients with MMD than middle cerebral artery (MCA) occlusion or healthy controls, and may have a connection with the MMD grades. Methods We recruited 68 MMD patients and 25 MCA occlusion patients diagnosed by angiography, including 29 patients without cerebrovascular problems as controls. We examined the plasma apelin, serum nitric oxide (NO), and vascular endothelial growth factor (VEGF) levels of all subjects by ELISA kit. We compared the relationship between apelin, NO, and VEGF in the blood of three groups, to explore the relationship. We also investigated whether the plasma apelin-13, apelin-17, and apelin-36 levels correlate with the MMD classification. Results Univariate analyses indicated that the MMD group had the higher plasma apelin-13, apelin-17, apelin-36, and serum NO levels than the MCA occlusion and healthy control groups. Binary logistic regression analyses further showed that the apelin-13 level was substantially higher in MMD patients than in MCA occlusion patients. Patients with MMD were significantly younger than patients with MCA occlusion by their mean ages. Linear regression analyses were performed to compare apelin levels between different grades of the patients with MMD. Apelin-13, apelin-17, and apelin-36 levels increased with the gradual increase of compensation grades level independent of NO and VEGF. Apelin-13 and apelin-36 showed a positive effect on the compensation scores in MMD. Conclusion Our study demonstrated that apelin-13 was significantly increased in patients with MMD than patients with MCA occlusion independent of NO and VEGF. Moreover, plasma apelin-13, apelin-17, and apelin-36 levels increase with the grades of MMD.
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Affiliation(s)
- Hanlin Wu
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Chengyu Xia
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Rui Li
- Department of Neurology, The First Affiliated Hospital of USTC, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Chunrong Tao
- Department of Neurology, The First Affiliated Hospital of USTC, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Qiqiang Tang
- Department of Neurology, The First Affiliated Hospital of USTC, Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Wei Hu
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
- Correspondence: Wei Hu; Qiqiang Tang Email ;
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Han Q, Yao F, Zhang Z, Huang Y. Evaluation of Revascularization in Different Suzuki Stages of Ischemic Moyamoya Disease by Whole-Brain CT Perfusion. Front Neurol 2021; 12:683224. [PMID: 34367049 PMCID: PMC8343098 DOI: 10.3389/fneur.2021.683224] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/28/2021] [Indexed: 12/12/2022] Open
Abstract
Objective: This study compared the clinical features and hemodynamic characteristics of patients in different Suzuki stages of ischemic moyamoya disease (iMMD) before and after treatment with extracranial-intracranial (EC-IC) bypass surgery combined with encephalo-duro-myo-synangiosis and whole-brain computed tomography perfusion (WB-CTP). Methods: A total of 126 patients in different Suzuki stages (II, III, IV, and V) of iMMD who underwent bypass surgery from April 2013 to August 2020 were included in this retrospective study. MIStar automatic analysis of Whole brain CT perfusion imaging software (WB-CTP, Apollo Medical Imaging Technology, Melbourne, Australia) was used. The patients also underwent WB-CTP 1 day before and 1 week and 3 months after the surgery. The relationships between hemodynamic parameters in WB-CTP including delay time (DT) > 3 s, relative cerebral blood flow (rCBF) < 30%, mismatch and mismatch ratio, and clinical outcomes were evaluated for different Suzuki stages, with comparisons between early (II and III) and late (IV and V) stages. Results: Combined bypass surgery was performed in 161 hemispheres of 126 patients with iMMD. Brain volume with DT > 3 s was decreased 1 week (51.5 ± 11.8 ml, P < 0.05) and 3 months (41.5 ± 10.7 ml, P < 0.05) after bypass compared to 1 day before bypass (104.7 ± 15.1 ml) in early-stage patients. In late-stage patients, the volume was increased 1 week after bypass compared to the preoperative value (154.3 ± 14.7 vs. 118.3 ± 19.1 ml, P < 0.05). Preoperative brain volume with rCBF < 30% was lower (9.8 ± 3.9 vs. 33.5 ± 11.0 ml) whereas preoperative mismatch ratio was higher (11.2 ± 2.8 vs. 3.6 ± 1.6) in early-stage as compared to late-stage patients (both P < 0.05). A higher modified Rankin scale score (0–1) was achieved by early-stage patients than by those in the late stage (93.8 vs. 80.4%, P < 0.05) at the 3-month follow-up. Conclusions: WB-CTP is useful for assessing the effectiveness of combined bypass/revascularization in different Suzuki stages of iMMD. Patients in the early stage of disease with higher preoperative brain volume with DT > 3 s and mismatch ratio show greater improvements in hemodynamic parameters and fewer postoperative complications associated with hemodynamic disturbance following bypass than patients in the late stage. Preoperative mismatch ratio can serve as a marker for assessing the status of collateral circulation in different Suzuki stages of iMMD.
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Affiliation(s)
- Qingdong Han
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feirong Yao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhengyu Zhang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yabo Huang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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Preoperatively estimated graft flow rate contributes to the improvement of hemodynamics in revascularization for Moyamoya disease. J Stroke Cerebrovasc Dis 2020; 30:105450. [PMID: 33171424 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/06/2020] [Accepted: 10/31/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass operation is an effective treatment for patients with Moyamoya disease, and the hemodynamic parameters are reported to be improved after operation. However, there is no report concerning hemodynamic changes from the viewpoint of the preoperative anatomical structure of grafts. In this study, we evaluated the correlation between the preoperatively estimated blood flow of the graft obtained through image-based computational fluid dynamics (CFD) analysis and the hemodynamic changes in the acute phase after revascularization. MATERIALS AND METHODS A total of 30 hemispheric sides of 23 patients were examined. The blood flow, that is, flow rate (FR) of the STA branches that were anastomosed to the MCA was evaluated using CFD analysis based on computed tomography (CT) angiography imaging data. The correlations between the FR and the hemodynamic changes in the acute phase after revascularization obtained through CT perfusion were assessed. RESULTS The preoperatively estimated FR of the graft was moderately correlated with the changes in the mean transit time significantly and weakly correlated with those in the cerebral blood flow and cerebral blood volume. In addition, the FR was strongly correlated with age and the diameter of the STA from the origin to the bifurcation. CONCLUSION The preoperatively estimated FR of the graft obtained through image-based CFD analysis contributed to the improvement of the mean transit time after revascularization. Because the FR of the graft was associated with the diameter of the STA, the size of the STA might be an important factor in postoperative hemodynamic changes. This might lead to the risk assessment of acute drastic hemodynamic changes as cerebral hyperperfusion, and consequently, better surgical outcomes might be expected.
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Berry JA, Cortez V, Toor H, Saini H, Siddiqi J. Moyamoya: An Update and Review. Cureus 2020; 12:e10994. [PMID: 33209550 PMCID: PMC7667711 DOI: 10.7759/cureus.10994] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 10/12/2020] [Indexed: 12/04/2022] Open
Abstract
This article is a clinical review of Moyamoya disease (MMD) and Moyamoya syndrome (MMS). We review the incidence, epidemiology, pathology, historical context, clinical and radiographic findings, diagnostic imaging modalities, radiographic grading systems, the effectiveness of medical, interventional, and surgical treatment, and some of the nuances of surgical treatment options. This article will help pediatricians, neurologists, neurosurgeons, and other clinical practitioners who are involved in caring for patients with this rare clinical entity. MMD is an intrinsic primary disease process that causes bilateral progressive stenosis of the anterior intracranial circulation with the involvement of the proximal portions of the intracranial internal carotid artery (ICA) extending to involve the proximal portions of the anterior cerebral artery (ACA) and middle cerebral artery (MCA); posterior circulation involvement is very rare. This causes a compensatory response where large numbers of smaller vessels such as the lenticulostriate arteries begin to enlarge and proliferate, which gives the angiographic appearance of a "Puff of Smoke", which is translated into Japanese as "Moyamoya". MMS is a secondary process that occurs in response to another underlying pathological process that causes stenosis of intracranial blood vessels, such as radiation. For example, an external source of radiation causes stenosis of the ICA with a compensatory response of smaller blood vessels, which then enlarge and proliferate in response and has the same "Puff of Smoke" appearance on the diagnostic cerebral angiogram (DCA). Histological findings include an irregular internal elastic lamina with luminal narrowing, hyperplasia of the tunica media, and intimal thickening with vacuolar degeneration in smooth muscle cells in the tunica media. Compensation for diminishing blood supply occurs through angiogenesis, which causes the proliferation and enlargement of smaller collateral blood vessels to increase blood supply to under-perfused areas of the brain. MMD is rare in the United States, with just 0.086 newly diagnosed cases per 100,000 individuals per year, which is approximately one per million new cases annually. Risk factors for MMD include Eastern Asian ancestry and predisposing conditions such as neurofibromatosis and Down's syndrome. Clinically, patients often present with stroke signs and symptoms from cerebral ischemia. The proliferation of collateral blood vessels within the basal ganglia can produce movement disorders. Catheter-based DCA is the current gold standard for obtaining a diagnosis. CT perfusion allows preoperative identification of ischemic vascular territories, which may be amenable to surgical intervention. MRI enables rapid detection of acute ischemic stroke using diffusion-weighted Imaging (DWI) and apparent diffusion coefficient (ADC) sequences to assess for any diffusion restriction. Non-contrast CT of the head is used to rule out acute hemorrhage in the presentation of a progressive neurological deficit. The treatment option for Moyamoya is generally surgical; medical treatment has failed to halt disease progression and neuro-interventional techniques such as attempted stenting of stenosed vessels have failed. Surgical options include direct and indirect cerebrovascular bypass.
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Affiliation(s)
- James A Berry
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Vladimir Cortez
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Harjyot Toor
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Harneel Saini
- Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Javed Siddiqi
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
- Neurosurgery, California University of Science and Medicine, Colton, USA
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12
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Shi Z, Ma G, Zhang D. Haemodynamic analysis of adult patients with moyamoya disease: CT perfusion and DSA gradings. Stroke Vasc Neurol 2020; 6:41-47. [PMID: 32883875 PMCID: PMC8005907 DOI: 10.1136/svn-2019-000317] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/10/2020] [Accepted: 07/02/2020] [Indexed: 11/13/2022] Open
Abstract
Object Moyamoya disease (MMD) is a common and chronic progressive stenotic-occlusive cerebrovascular disease in Eastern Asia. To evaluate the hemispheric haemodynamic status of adult patients with MMD, we explored the potential risk factors of hemispheric perfusion alterations with CT perfusion (CTP) and DSA. Methods We retrospectively reviewed 44 male and 44 female (176 hemispheres) adult patients with MMD who had both DSA and CTP. Data on cerebral blood perfusion (CBF), cerebral blood volume (CBV), mean transmit time (MTT), time to peak (TTP) of cerebral hemisphere and cerebellum were gathered and difference of relative haemodynamic parameters between different subgroups were assessed with independent sample t analysis, one-way analysis of variance and general linear regression analysis. Results Parameters in regional CBF (rCBF) of frontal, temporal lobe and basal ganglia in female was more superior than male. rCBF, regional MTT (rMTT) and regional TTP (rTTP) in adult MMD patients with haemorrhage were superior than the ischaemic. With the increase of age, significant difference could be seen in rCBF and rCBV of thalamus. However, with progress of arterial stenosis, significant difference could only be obsevrved in rCBV, rMTT and rTTP, whereas rCBF had no significant difference. For increase of moyamoya vessels, significant decrease of rCBF could be seen in temporal and parietal lobe. With the increase of compensatory artery numbers, no significant difference could be seen in rCBF parameters (p>0.05). Conclusions In adult MMD patients, age, gender and clinical type were potential risk factors for the change of cerebral perfusion. When arterial stenosis is worsened, moyamoya vessels could alter perfusion of temporal and parietal lobe, but not frontal lobe. Extracranial/intracranial compensatory arteries could maintain microcirculation stability in frontal lobe and basal ganglia, indicating that the protection from extracranial compensatory arteries, a theoretic base for surgery treatment if necessary.
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Affiliation(s)
- Zhiyong Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guofeng Ma
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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13
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Arterial transit artifacts observed by arterial spin labeling in Moyamoya disease. J Stroke Cerebrovasc Dis 2020; 29:105058. [PMID: 32807463 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105058] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Arterial spin labeling (ASL) is a magnetic resonance imaging (MRI) technique used to assess cerebral perfusion. When tissue perfusion is impaired, such as in Moyamoya disease, a hyperintense band called the arterial transit artifact (ATA) may occur, which interferes with accurate measurements on ASL-MRI. In this study, we evaluated the correlation of ATAs with magnetic resonance angiography (MRA) and single-photon emission computed tomography (SPECT) imaging results in Moyamoya disease. The aim of our study was to elucidate the pathophysiology of ATAs and risk factors for high ATA scores. MATERIALS AND METHODS This retrospective study included 28 patients (56 hemispheres) with Moyamoya disease treated at our institution. MRI, MRA, ASL perfusion, and N-isopropyl-[123I] b-iodoamphetamine (123I-IMP) SPECT were performed. In order to semi-quantitatively evaluate the degree of ATA, the ATA scores were measured according to the number of hyperintense signal bands in the cerebral cortex. The relationship between the ATA scores and clinical and radiological factors were analyzed. RESULTS Regional cerebral blood flow (rCBF) determined with ASL weakly correlated with that determined by 123I-IMP SPECT (ρ=0.31, p=0.027). There was no significant association between the ATA scores and rCBF values determined with 123I-IMP SPECT (p=0.872, 0.745, 0.743 at PLD1000 (post-labeling delay), 1500, and 2000, respectively). However, there was a significant correlation between ATA scores and MRA scores (ρ=0.427 p=0.001; ρ=0.612 p=0.001; ρ=0.563 p=0.001 at PLD1000, 1500, and 2000, respectively). An analysis of patient background characteristics revealed a significantly higher incidence of high ATA scores in female patients, patients with high MRA scores, and patients with a distinguishable ivy sign. A multivariate analysis confirmed that female sex, high MRA score, and presence of an ivy sign were risk factors for high ATA scores. CONCLUSION ATA scores were moderately correlated with MRA scores, and presence of an ivy sign was the most predictive factor for high ATA scores. A high ATA score determined using ASL in a patient with Moyamoya disease might suggest an advanced disease stage and a reduction in cerebrovascular reserve capacity.
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14
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Kang K, Ma N, Li J, Shen Y, Gu W, Ma G, Zhang D, Zhao X. Cerebral Hemodynamic Changes After Revascularization in Patients With Hemorrhagic Moyamoya Disease. Front Neurol 2020; 11:72. [PMID: 32117031 PMCID: PMC7026453 DOI: 10.3389/fneur.2020.00072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/21/2020] [Indexed: 01/29/2023] Open
Abstract
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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Affiliation(s)
- Kaijiang Kang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Ning Ma
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jinxin Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yuan Shen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Weibin Gu
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guofeng Ma
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dong Zhang
- China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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15
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Yu J, Zhang J, Li J, Zhang J, Chen J. Cerebral Hyperperfusion Syndrome After Revascularization Surgery in Patients with Moyamoya Disease: Systematic Review and Meta-Analysis. World Neurosurg 2019; 135:357-366.e4. [PMID: 31759149 DOI: 10.1016/j.wneu.2019.11.065] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cerebral hyperperfusion syndrome (CHS) after bypass surgery is known as a complication of moyamoya disease (MMD). However, the incidence of CHS has not been accurately reported, and there is no consensus on related risk factors. OBJECTIVE To evaluate the incidence and characteristics of CHS in patients with MMD after revascularization surgery via meta-analysis. METHODS Relevant cohort studies were retrieved through a literature search of PubMed, Embase, and Ovid until December 1, 2018. Eligible studies were identified per search criteria. A systematic review and meta-analysis were used to assess the CHS total incidence, incidence in pediatric patients with MMD and adult patients with MMD, incidence for direct and combined bypass surgery, progress rate, and proportion of each symptom (including transient neurologic deficits [TNDs], hemorrhage, and seizure). RESULTS A total of 27 cohort studies with 2225 patients were included in this meta-analysis. The weighted proportions per random-effects model were 16.5% (range, 11.3%-22.3%) for CHS total incidence, 3.8% (range, 0.3%-9.6%) for pediatric patients with MMD, 19.9% (range, 11.7%-29.4%) for adult patients with MMD, 15.4% (range, 5.4%-28.8%) for direct bypass surgery, and 15.2% (range, 8.4%-23.2%) for combined bypass surgery. Progress rate was 39.5% (range, 28.7%-50.8%). The most common CHS-related symptom was TNDs (70.2%; range, 56.3%-82.7%), followed by hemorrhage (15.0%; range, 5.5%-26.9%) and seizure (5.3%; range, 0.6%-12.9%). CONCLUSIONS CHS is a common complication after revascularization surgery in MMD. It is more frequently seen in adult patients. The most common CHS-related symptom was TNDs, followed by hemorrhage and seizure.
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Affiliation(s)
- Jin Yu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jibo Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jieli Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jianjian Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
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16
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Yin H, Liu X, Zhang D, Zhang Y, Wang R, Zhao M, Zhao J. A Novel Staging System to Evaluate Cerebral Hypoperfusion in Patients With Moyamoya Disease. Stroke 2019; 49:2837-2843. [PMID: 30571396 DOI: 10.1161/strokeaha.118.022628] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- The study goal was to evaluate cerebral perfusion in moyamoya patients with a novel staging system and investigate the association between differences of perfusion status and clinical outcomes in patients treated with revascularization. Methods- About 506 consecutive patients from 2009 to 2015 were enrolled. The perfusion status was evaluated by a staging system-the stage of preinfarction period based on the result of computed tomography perfusion. Hemisphere in different perfusion stage was compared between hemorrhagic patients (n=155) and ischemic patients (n=351). The modified Rankin Scale was applied to evaluate the prognosis of patients. Results- In the enrolled 506 patients: 229 hemispheres (22.6%) with normal perfusion, 72 hemispheres (7.1%) in stage I, 205 hemispheres (20.3%) in stage II, 308 hemispheres (30.4%) in stage III, and 198 hemispheres (19.6%) in stage IV. Significant difference was observed in stage distribution between hemorrhagic patients and ischemic patients ( P<0.01). The ratio of hemispheres with normal perfusion in hemorrhagic group is more than the ischemic group ( P<0.05; odds ratio, 1.440; 95% CI, 1.144-1.811). The ratio of hemispheres in stage III in ischemic group is more than the hemorrhagic group ( P<0.01; odds ratio, 0.618, 95% CI, 0.487-0.783). In the prognosis-related analysis, the stage I group has the highest improved ratio (73.9%) and the normal perfusion group has the lowest improved ratio (33.3%). The improved ratio has a decreasing tendency from stage I to stage IV. Conclusions- The novel preinfarction staging system is a valuable assessment tool to evaluate cerebral perfusion status in moyamoya patients and predict the efficacy of revascularization. Ischemic patients suffer more from hypoperfusion. Patients in stage I and stage II are more likely to obtain improvement after revascularization. This is a retrospective study.
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Affiliation(s)
- Hu Yin
- From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)
| | - Xingju Liu
- From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)
| | - Dong Zhang
- From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)
| | - Yan Zhang
- From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)
| | - Rong Wang
- From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)
| | - Meng Zhao
- From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)
| | - Jizong Zhao
- From the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,China National Clinical Research Center for Neurological Diseases, Beijing (NCRC-ND) (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Center of Stroke, Beijing Institute for Brain Disorders (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (H.Y., X.L., D.Z., Y.Z., R.W., M.Z., J.Z.)
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17
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Patchana T, Dorkoski R, Zampella B, Wiginton JG, Sweiss RB, Menoni R, Miulli DE. The Use of Computed Tomography Perfusion on Admission to Predict Outcomes in Surgical and Nonsurgical Traumatic Brain Injury Patients. Cureus 2019; 11:e5077. [PMID: 31516787 PMCID: PMC6721926 DOI: 10.7759/cureus.5077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction: The objective of this study was to investigate if data obtained from a computed tomography (CT) perfusion study on admission could correlate to outcomes for the patient, including the patient’s length of stay in the hospital and their initial and final Glasgow Coma Scale (GCS), as well as the modified Rankin Scale (mRS) on discharge. We present an initial subset of patients fulfilling the inclusion criteria: over the age of 18 with mild, moderate, or severe traumatic brain injury (TBI). Patients admitted with a diagnosis of TBI had CT perfusion studies performed within 48 hours of admission. GCS, length of stay, mRS, and discharge location were tracked, along with the patient’s course of hospitalization. Initial results and discussion on the utility of CT perfusion for predicting outcomes are presented. Methods: Patients exhibiting mild, moderate, or severe TBI were assessed using CT perfusion within 48 hours of admission from January to July 2019 at the Arrowhead Regional Medical Center (ARMC). The neurosurgery census and patient records were assessed for progression of outcomes. Data obtained from the perfusion scans were correlated to patient outcomes to evaluate the utility of CT perfusion in predicting outcomes in surgical and nonsurgical TBI patients. Results: Preliminary data were obtained on six patients exhibiting TBI, ranging from mild to severe. The mean GCS of our patient cohort on admission was eight, with the most common mechanism of injury found to be falls (50%) and motor vehicle accidents (50%). Cerebral blood volume (CBV) seemed to increase with Rankin value (Pearson's correlations coefficient = 0.43 but was statistically insignificant (P = 0.21)). Cerebral blood flow (CBF) was found to be correlated with CBV, and both increased with Rankin score (Pearson's correlation coefficient = 0.56) but were statistically insignificant (P = 0.27). These results suggest that with a larger sample size, CBV and CBF may be correlated to patient outcome. Conclusion: Although more data is needed, preliminary results suggest that with larger patient populations, CT perfusion may provide information that can be correlated clinically to patient outcomes. This study shows that CBF and CBV may serve as useful indicators for prognostication of TBI patients.
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Affiliation(s)
- Tye Patchana
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Ryan Dorkoski
- Environmental and Plant Science, Ohio University, Athens, USA
| | - Bailey Zampella
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James G Wiginton
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Raed B Sweiss
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Rosalinda Menoni
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Dan E Miulli
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
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18
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Predictive factors for acute thrombogenesis occurring immediately after bypass procedure for moyamoya disease. Neurosurg Rev 2019; 43:609-617. [PMID: 30767097 DOI: 10.1007/s10143-019-01086-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/18/2019] [Accepted: 02/07/2019] [Indexed: 12/11/2022]
Abstract
Extracranial-to-intracranial (EC-IC) bypass surgery is an effective treatment for patients with moyamoya disease and other conditions. Some patients with moyamoya disease have a risk of acute thrombogenesis at the anastomotic site just after bypass surgery. The purpose of this study was to study risk factors of acute thrombogenesis and determine effective countermeasures. This study included 48 patients (66 EC-IC bypass procedures) with moyamoya disease and 52 controls (54 procedures) without moyamoya disease. The development of acute thrombogenesis was compared between the moyamoya disease and control groups. In the moyamoya disease group, clinical and radiological characteristics were assessed with respect to acute thrombogenesis. In the patients with acute thrombogenesis, causes of technical problems were retrospectively examined. The incidence of acute thrombogenesis was significantly higher in the moyamoya disease group than those in the control group. In the moyamoya disease group, acute thrombogenesis was observed in seven patients. In the moyamoya disease group, the magnetic resonance angiography (MRA) scores were significantly higher in patients with acute thrombogenesis than those in the patients without acute thrombogenesis. In the multivariate analysis, the predictive factor of acute thrombogenesis in moyamoya disease was a high MRA score (odds ratio, 2.336; p = 0.009). During EC-IC bypass surgery for moyamoya disease, acute thrombogenesis should be considered to obtain a high patency rate, particularly in patients with high MRA scores. Acute thrombogenesis will not influence morbidity if proper countermeasures are followed; therefore, the prediction and recognition of white thrombus are important for a successful bypass surgery.
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19
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Tao X, Liu Y, Chen J, Xu L, Zhou Z, Lei H, Yin Y. Assessment of Single-Barrel Superficial Temporal Artery-Middle Cerebral Artery Bypass in Treatment for Adult Patients with Ischemic-Type Moyamoya Disease. Med Sci Monit 2018; 24:7469-7474. [PMID: 30339661 PMCID: PMC6203936 DOI: 10.12659/msm.910252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/21/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Moyamoya disease (MMD) is an idiopathic disease caused by progressive steno-occlusion of the distal internal carotid artery. Ideal surgical treatment for adult patients with ischemic-type MMD has not been achieved. The aim of this study was to evaluate the efficacy of single-barrel superficial temporal artery-middle cerebral artery (STA-MCA) bypass in treatment for adult patients with ischemic-type MMD by analyzing clinical and radiological data retrospectively. MATERIAL AND METHODS The present study included 37 patients with non-hemorrhagic MMD, including 21 women and 16 men (21~55 years old, mean age 38.1 years). The bypass surgery was performed on 56 sides in the 37 patients. The clinical charts, angiographic revascularization, and hemodynamic changes were reviewed at 6-60 months after surgery. RESULTS Among the 37 patients, the clinical symptoms and signs of 32 patients were improved or stabilized. Five patients had complications, including 2 cases of acute cerebral infarction, 1 case of epidural hematoma, and 1 case of transient speech disturbance, and 1 patient died. Follow-up computed tomography perfusion (CTP) revealed that cerebral blood flow (CBF) was markedly improved after surgery (P<0.05). Time to peek (TTP) and mean transit time (MTT) were significantly decreased after surgery (P<0.05). No significant change in cerebral blood volume (CBV) was found after surgery (P>0.05). Postoperative patency was clearly verified in 52 bypasses (92.8%) of 56 bypasses on follow-up DSA imaging. CONCLUSIONS Single-barrel STA-MCA bypass can be considered as an effective surgical treatment, which exhibits satisfactory clinical efficacy in ischemic-type MMD patients.
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Affiliation(s)
- Xiaoyang Tao
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, P.R. China
| | - Yin Liu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, P.R. China
| | - Jun Chen
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, P.R. China
| | - Li Xu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, P.R. China
| | - Zhijie Zhou
- Department of Neurosurgery, Suzhou Wuzhong People’s Hospital, Suzhou, Jiangsu, P.R. China
| | - Haiyan Lei
- Department of Medical Imaging, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, P.R. China
| | - Yiming Yin
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, P.R. China
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Xu S, Zhang J, Wang S, Li Z, Xiong Z, Wu X, Xin C, Wang H, Wang Y, Chen J. The Optimum Operative Time of Revascularization for Patients with Moyamoya Disease Following Acute Onset. World Neurosurg 2018. [DOI: 10.1016/j.wneu.2018.02.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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