Abstract
Moyamoya disease leads to the formation of stenosis in the cerebrovasculature. A superficial temporal artery to middle cerebral artery (STA-MCA) bypass is an effective treatment for the disease, yet it is usually associated with postoperative cerebral hyperperfusion syndrome (CHS). This study aimed to evaluate cerebral hemodynamic changes immediately after surgery and assess whether a semiquantitative analysis of an intraoperative magnetic resonance perfusion-weighted image (PWI) is useful for predicting postoperative CHS. Fourteen patients who underwent the STA-MCA bypass surgery were included in this study. An atlas-based registration method was employed for studying hemodynamics in different cerebral regions. Pre- versus intraoperative and group-wise comparisons were conducted to evaluate the hemodynamic changes. A postoperative increase in relative cerebral blood flow (CBF) at the terminal MCA territory (P = 0.035) and drop in relative mean-time-transit at the central MCA territory (P = 0.012) were observed in all patients. However, a significant raise in the increasing ratio of relative-CBF at the terminal MCA territory was only found in CHS patients (P = 0.023). The cerebrovascular changes of the patients after revascularization treatment were confirmed. Intraoperative PWI might be helpful in predicting the change in relative-CBF at MCA terminal territory which might indicate a risk of CHS.
Highlights
superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis was traditionally considered to provide a low-flow bypass for MMD patients
Some combined with the imaging criteria that cerebral blood flow (CBF) increases greater than 100% over the baseline of the contralateral MCA territory after the procedure are identified either by perfusion imaging, positron emission tomography (PET) or single-photon emission computed tomography (SPECT) imaging[8]
To the best of our knowledge, intraoperative Perfusion-weighted magnetic resonance imaging (PWI) has not been reported in the usage of monitoring STA-MCA bypass surgery
Summary
STA-MCA anastomosis was traditionally considered to provide a low-flow bypass for MMD patients It is associated with postoperative symptomatic cerebral hyperperfusion syndrome (CHS) with a high incidence of 16.7%–71.4%, which might lead to severe neurological deficits[2,3]. PWI reflects hemodynamic information of the brain tissue and subsequently obtains quantitative information through calculations of the mathematical models, including cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT)[7]. This technique is theoretically an effective tool in assessing the surgical effect and predicting postoperative CHS following cerebral revascularization surgery.
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