Postoperative neovascularization, cerebral hemodynamics, and clinical prognosis between combined and indirect bypass revascularization procedures in hemorrhagic moyamoya disease

• Published in: Clinical neurology and neurosurgery Vol. 208; p. 106869
• Main Authors: Sun, Jun, Li, Zhang-Yu, Chen, Chuan, Ling, Cong, Li, Hao, Wang, Hui
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2021; Elsevier Limited
• Subjects: Adult; Anastomosis; Blood; Blood flow; Cerebral blood flow; Cerebral hemispheres; Cerebral Revascularization - adverse effects; Cerebral Revascularization - methods; Cerebrovascular Circulation - physiology; Combined bypass; Female; Hemodynamics; Hemodynamics - physiology; Hemorrhage; Hemorrhagic moyamoya disease; Humans; Indirect bypass; Male; Middle Aged; Mortality; Moyamoya disease; Moyamoya Disease - diagnostic imaging; Moyamoya Disease - pathology; Moyamoya Disease - surgery; Neovascularization, Pathologic - diagnostic imaging; Neovascularization, Pathologic - etiology; Neovascularization, Pathologic - pathology; Neurology; Neurosurgery; Patients; Postoperative collateral formation; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Postoperative Complications - pathology; Prognosis; Regression analysis; Stroke; Surgery; Treatment Outcome; Vascularization; Veins & arteries; rCBF; Hemorrhagic moyamoya disease; Indirect bypass; EDAMS; MMD; rTTP; MTT; mRS; Combined bypass; CTA; rCBV; DSA; Postoperative collateral formation; STA-MCA; Hemodynamics; CTP; superficial temporal artery-to-middle cerebral artery anastomosis; moyamoya disease; digital subtraction angiography; computed tomography angiography; encephaloduroarteriomyosynangiosis; modified Rankin scale; mean transit time; computed tomography perfusion; relative cerebral blood volume; relative cerebral blood flow; relative time to peak
• ISSN: 0303-8467; 1872-6968; 1872-6968
• DOI: 10.1016/j.clineuro.2021.106869

We evaluated what few studies emphasized the postoperative collateral formation and cerebral hemodynamics of hemorrhagic moyamoya disease (MMD). Hemorrhagic MMD patients treated surgically were retrospectively collected and dichotomized into combined bypass (CB) and indirect bypass (IB) groups. CB used superficial temporal artery-to-middle cerebral artery anastomosis combined with encephaloduroarteriomyosynangiosis (STA-MCA+EDAMS), and IB used encephaloduroarteriomyosynangiosis (EDAMS) for revascularization. Postoperative complications and clinical prognosis, as well as pre- and post-operative Modified Rankin Scale (mRS), collateral circulation status, and cerebral hemodynamics were observed and compared between the CB and IB groups. A total of 37 patients with hemorrhagic MMD were identified. Of the 68 cerebral hemispheres, 47(69.1%) were combined revascularization, and the rest were indirect. During an average follow-up of 16.5 ± 8.7 months, the recurrent stroke events were significantly lower, as well as having a postoperative mRS scores≤ 2. A satisfactory postoperative collateral formation, and an improved dilation or extension of the anterior choroidal/posterior communication artery (AchA/PcoA) were significantly higher in the CB group than in the IB group (all P < .05). Compared with preoperative cerebral hemodynamics, relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), mean transit time (MTT), and relative time to peak (rTTP) in the CB group; rCBF, rCBV, and MTT in the IB group were significantly improved (all P < .001). The CB group’s postoperative rCBF was significantly improved compared with the IB group (P < .001). STA-MCA bypass combined with EDAMS can obtain better postoperative collateral formation, cerebral hemodynamics, and clinical prognosis than EDAMS alone. •CB significantly ameliorate the deterioration of neurofunction and postoperative complications.•CB improves extension and dilation of AchA-PcoA and reduces rehemorrhage rate more significant than IB.•CB can better improve postoperative neoangiogenesis and cerebral hemodynamics than IB.