Imaging methods for surgical revascularization in patients with moyamoya disease: an updated review

Feng Yan,Chenyun Zhou,Hanyu Jiang,Lanxin Du,Jin Li,Ting Duan

doi:10.1007/s10143-021-01596-0

Abstract

Neuroimaging is crucial in moyamoya disease (MMD) for neurosurgeons, during pre-surgical planning and intraoperative navigation not only to maximize the success rate of surgery, but also to minimize postsurgical neurological deficits in patients. This is a review of recent literatures which updates the clinical use of imaging methods in the morphological and hemodynamic assessment of surgical revascularization in patients with MMD. We aimed to assist surgeons in assessing the status of moyamoya vessels, selecting bypass arteries, and monitoring postoperative cerebral perfusion through the latest imaging technology.

Highlights

Moyamoya disease (MMD) is an uncommon cerebrovascular disease characterized by progressive stenosis of the terminal portion of the internal carotid artery (ICA) and its main branches [37]
The stenotic degree of the ICA, the compensatory ability of the collateral circulation, the selection of bypass area and the matching of bypass vessels, and the monitoring of postoperative cerebral perfusion are the key points that surgeons care about, which cannot be separated from the support of neuroimaging
The PubMed, Ovid, Embase, and Cochrane databases were searched over a 20-year period between 2001 to 2021 using the Boolean search term (“moyamoya disease” OR “moyamoya syndrome” OR “MMD”) AND (“revascularization” OR “bypass surgery” OR “STA-MCA bypass” OR “direct surgery” OR “indirect surgery”) AND (“imaging” OR “Computed tomography” OR “Digital subtraction angiography” OR “Magnetic resonance imaging” OR “Singlephoton emission computed tomography” OR “Positron emission tomography” OR “Fluorescence imaging” OR “Ultrasonography”)

Summary

Introduction

Moyamoya disease (MMD) is an uncommon cerebrovascular disease characterized by progressive stenosis of the terminal portion of the internal carotid artery (ICA) and its main branches [37]. The hemorrhagic and ischemic types are the two main clinical manifestations. The stenotic degree of the ICA, the compensatory ability of the collateral circulation, the selection of bypass area and the matching of bypass vessels, and the monitoring of postoperative cerebral perfusion are the key points that surgeons care about, which cannot be separated from the support of neuroimaging. The concepts of “flow-controlled bypass” and “precised bypass” have been put forward, aiming to improve the cerebral perfusion in preoperatively ischemic areas, reduce the ineffective bypass, and reduce the cerebral hyper-perfusion syndrome (CHS) caused by excessive bypass

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