Artikel
Longitudinal effects of combined bypass surgery on abnormal collateral channels in moyamoya disease
Längswirkungen der kombinierten Bypass-Chirurgie auf abnorme Nebenkanäle bei der Moyamoya-Krankheit
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Veröffentlicht: | 26. Juni 2020 |
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Objective: In moyamoya disease (MMD), dilated perforating arteries such as lenticulostriate arteries and thalamic perforators, and anterior and posterior choroidal arteries often abnormally anastomose with medullary arteries in periventricular area and retrogradely supply collateral blood flow to ischemic cerebral cortex. These abnormal collateral channels have been recognized as the potential bleeding source in hemorrhagic MMD. Therefore, to regress the abnormal collateral channels is one of the purposes of surgical revascularization for MMD, especially hemorrhagic type. Present study was aimed to clarify if our surgical procedure, superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and encephalo-duro-myo-arterio-pericranio-synangiosis (EDMAPS) can regress the abnormal collateral channels in adult and pediatric patients with MMD.
Methods: Suzuki’s angiographical stage and development of three subtypes of collateral channels including lenticulostriate, thalamic, and choroidal channels were evaluated on cerebral angiography before and 3-6 months after combined bypass surgery. Development of abnormal collateral channels was categorized into 3 grades (Grade 0, 1, and 2) based on degree of their extension. Postoperative advancement of Suzuki's stage and regression of abnormal collateral channels were statistically analyzed.
Results: Present study included 63 involved hemispheres of 44 adult patients and 29 of 17 pediatric patients with MMD who underwent combined bypass surgery and cerebral angiography before and after surgery. Suzuki’s angiographical stage was significantly advanced after surgery in both adult and pediatric hemispheres (P=0.042 and P<0.001, respectively). Lenticulostriate, thalamic, and choroidal channels were significantly regressed in adult hemispheres after surgery (P<0.001, P=0.012, and 0.0028, respectively (Figure 1A [Fig. 1])). In pediatric hemispheres, lenticulostriate and choroidal channels were significantly regressed (P=0.0050, 0.034, respectively (Figure 1B [Fig. 1])). Representative case is shown in Figure 2 [Fig. 2]. No ischemic and hemorrhagic stroke occurred during follow-up periods (40.2±25.5 and 54.9±19.7 months in adult and pediatric patients, respectively).
Conclusion: STA-MCA anastomosis and EDMAPS was effective to prevent not only ischemic symptoms but also hemorrhagic event through remarkably regressing the abnormal collateral channels that can be the hemorrhagic source in MMD.