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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Clinical value of early postoperative CT-angiography imaging after EC-IC bypass in patients with Moyamoya

Klinische Bedeutung der frühen postoperativen CT-Angiographie nach EC-IC-Bypass-Anlage bei Moyamoya-Patienten

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  • presenting/speaker Helene Hurth - University Hospital Tübingen, Neurosurgery, Tübingen, Deutschland; University Hospital Tübingen, Center for Moyamoya and cerebral revascularization, Tübingen, Deutschland
  • Till-Karsten Hauser - University Hospital Tübingen, Neuroradiology, Tübingen, Deutschland
  • Patrick Haas - University Hospital Tübingen, Neurosurgery, Tübingen, Deutschland; University Hospital Tübingen, Center for Moyamoya and cerebral revascularization, Tübingen, Deutschland
  • Sophie Wang - University Hospital Tübingen, Neurosurgery, Tübingen, Deutschland; University Hospital Tübingen, Center for Moyamoya and Cerebral Revascularization, Tübingen, Deutschland
  • Ulrike Ernemann - University Hospital Tübingen, Neuroradiology, Tübingen, Deutschland
  • Marcos Tatagiba - University Hospital Tübingen, Neurosurgery, Tübingen, Deutschland; University Hospital Tübingen, Center for Moyamoya and Cerebral Revascularization, Tübingen, Deutschland
  • Nadia Khan - University Hospital Tübingen, Neurosurgery, Tübingen, Deutschland; Universitätskinderspital Zürich, Moyamoya Center, Zürich, Schweiz; University Hospital Tübingen, Center for Moyamoya and Cerebral Revascularization, Tübingen, Deutschland
  • Constantin Roder - University Hospital Tübingen, Neurosurgery, Tübingen, Deutschland; University Hospital Tübingen, Center for Moyamoya and Cerebral Revascularization, Tübingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV019

doi: 10.3205/21dgnc023, urn:nbn:de:0183-21dgnc0232

Published: June 4, 2021

© 2021 Hurth et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: To evaluate the clinical value of early postoperative computed tomographic angiography (CTA) after direct extracranial-intracranial (EC-IC) bypass surgery in moyamoya patients.

Methods: A retrospective analysis of all adult moyamoya patients treated at our center from 2013 to 2019 with a direct EC-IC bypass was performed. Early postoperative CTA (within 24 hours after surgery) was compared with conventional digital subtraction angiography (DSA) 6-12 months after surgery. If available, magnetic resonance time-of-flight angiography (MR-TOF) was evaluated 3 months and 6-12 months postoperatively as well. Imaging results were analyzed and compared with CTA, MR-TOF and DSA, whereat DSA was used as the final and definite modality to decide on bypass patency.

Results: A total of 103 direct EC-IC bypasses in 63 moyamoya patients were analyzed. All inclusion criteria were met in 33 patients (57 direct bypasses). In 82.5% the bypass appeared definitively, in 8.8% uncertainly and in 8.8% not patent according to early postoperative CTA. MR-TOF suggested definitive bypass patency in 87.5% 3 months after surgery and in 95.9% 6-12 months after surgery. Six-to-twelve months postoperative DSA showed a patency of 98.2% (56 of 57) of all bypasses. The positive predictive value (to correctly detect an occluded bypass) on postoperative CTA was 10%, the negative predictive value (to correctly detect a patent bypass) was 100% with a sensitivity of 100% and a specificity of 83.9%.

Conclusion: Early postoperative CTA has a high predictive value to confirm the patency of a bypass. On the other hand, a high false positive rate of (according to CTA) occluded bypasses after direct EC-IC bypass surgery can be seen. This must be considered critically when initiating possible clinical consequences if the bypass appears occluded in postoperative CTA.