Restoration of periventricular vasculature after direct bypass for moyamoya disease: intra-individual comparison

• Published in: Acta neurochirurgica Vol. 161; no. 5; pp. 947 - 954
• Main Authors: Miyakoshi, Akinori, Funaki, Takeshi, Takahashi, Jun C, Takagi, Yasushi, Kikuchi, Takayuki, Yoshida, Kazumichi, Kataoka, Hiroharu, Mineharu, Yohei, Okawa, Masakazu, Yamao, Yukihiro, Fushimi, Yasutaka, Okada, Tomohisa, Togashi, Kaori, Miyamoto, Susumu
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.05.2019; Springer Nature B.V
• Subjects: Adult; Anastomosis; Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - methods; Angiography; Cerebral Revascularization - adverse effects; Cerebral Revascularization - methods; Female; Heart surgery; Hemorrhage; Humans; Interventional Radiology; Magnetic Resonance Angiography - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Moyamoya disease; Moyamoya Disease - surgery; Neurology; Neuroradiology; Neurosurgery; Original Article - Vascular Neurosurgery - Other; Postoperative Complications - epidemiology; Surgery; Surgical Orthopedics; Thalamus; Vascular Neurosurgery – Other; Intracranial hemorrhage; Moyamoya disease; Cerebral revascularization; Periventricular anastomosis
• ISSN: 0001-6268; 0942-0940; 0942-0940
• DOI: 10.1007/s00701-019-03866-9

Background While periventricular anastomosis, a unique abnormal vasculature in moyamoya disease, has been studied in relation to intracranial hemorrhage, no study has addressed its change after bypass surgery. The authors sought to test whether direct bypass surgery could restore normal periventricular vasculature. Methods Patients who had undergone direct bypass surgery for moyamoya disease at a single institution were eligible for the study. Baseline, postoperative, and follow-up magnetic resonance angiography (MRA) scans were scheduled before surgery, after the first surgery, and 3 to 6 months after contralateral second surgery, respectively. Sliding-thin-slab maximum-intensity-projection coronal MRA images of periventricular anastomoses were scored according to the three subtypes (lenticulostriate, thalamic, and choroidal anastomosis). Baseline and postoperative MRA images were compared to obtain a matched comparison of score changes in the surgical and nonsurgical hemispheres within individuals (intra-individual comparison). Results Of 110 patients, 42 were identified for intra-individual comparisons. The periventricular anastomosis score decreased significantly in the surgical hemispheres (median, 2 versus 1; p  < 0.001), whereas the score remained unchanged in the nonsurgical hemispheres (median, 2 versus 2; p  = 0.57); the score change varied significantly between the surgical and nonsurgical hemispheres ( p  < 0.001). Of the 104 periventricular-anastomosis-positive hemispheres undergoing surgery, 47 (45.2%) were assessed as negative in the follow-up MRA. Among the subtypes, choroidal anastomosis was most likely to be assessed as negative (79.7% of positive hemispheres). Conclusions Periventricular vasculature can be restored after direct bypass. The likelihood of correction of choroidal anastomosis is a subject requiring further studies.