Article
Characterization of cortical vascularisation in moyamoya disease
Charakterisierung der kortikalen Vaskularisation bei Moyamoya-Erkrankung
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Published: | April 11, 2007 |
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Objective: Moyamoya disease is described as a stenoocclusive disease of cerebral arteries of the Circle of Willis with simultaneously occuring neovascularisation in the form of intracerebral and extra-intracranial collaterals. However, cortical vascularisation has not been quantified in patients before. It was the aim of this study to characterize cortical vascularisation in Moyamoya patients using intraoperative ICG videoangiography.
Methods: ICG videoangiography was performed in 10 Moyamoya patients intraoperatively before performing EC/IC-bypass and/or Encephalomyosynangiosis. In 6 patients (4 aneurysm patients, 2 tumor patients) ICG-videoangiography was performed after opening the dura and they were regarded as control patients. Cortical vascularisation was divided by hierarchy with the early filling arteries and their first branches referring to as arteries of 1st and 2nd order, respectively (macrocirculation). The same process was applied for the late filling veins and their branches (macrocirculation). Vascularisation occurring in 3rd or any following order were regarded as cortical microcirculation. Using intraoperative placement of a scale grid on the cortical surface, cortical vascularisation was assessed using CapImage software.
Results: ICG videoangiography revealed excellent visualisation of cortical arteries and veins as well as of microvascularisation in all patients. Moyamoya patients demonstrated significantly increased microvascular density as compared to control patients (Moyamoya: 18,5±2,44 cm/cm2, control: 14,08±3,68; p=0,011). No difference regarding cortical macrocirculation was quantified between both patient populations.
Conclusions: ICG videoangiography represents an excellent tool to assess cortical vascularisation intraoperatively. Moyamoya patients are characterized by a significantly increased microvascular density compared to controls. No difference regarding cortical macrocirculation was found.