Assessment of postoperative revascularization of adult patients with Moyamoya disease using MRI territory arterial spin labeling

Q4 Medicine

中华神经外科杂志 Pub Date : 2019-11-28 DOI:10.3760/CMA.J.ISSN.1001-2346.2019.11.003

Yu-jun Liao, Ziwei Fang, Zhenwei Yao, Bin Xu

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引用次数: 0

Abstract

Objective To assess postoperative revascularization of adult patients with Moyamoya disease (MMD) operated on with different surgical methods using the technology of MRI territory arterial spin labeling (T-ASL). Methods The clinical data of 84 adult MMD patients surgically treated at Department of Neurosurgery, Huashan Hospital, Fudan University from June 2018 to December 2018 were reviewed. Seventy patients received superficial temporal artery to middle cerebral artery bypass (STA-MCA bypass) combined with encephalo-duro-myo-synangiosis (EDMS) and were categorized into combined-bypass group. Fourteen patients underwent merely EDMS and categorized into indirect-bypass group. Digital subtraction angiography (DSA) and T-ASL were performed pre- and postoperatively. Matsushima staging system was applied to assess the outcome of revascularization. T-ASL scan used to investigate the revascularization area (RA) and perfusion of deep brain structures by external carotid artery (ECA) on operated side. Results The follow-up period of 84 patients ranged from 4 to 8 months (mean: 6.3±1.2 months). There was no difference in baseline data (sex, age, clinical presentations, and pre-surgical spontaneous collaterals), peri-operative complications, postoperative stroke control rate, Matsushima stage (grade A or B) between 2 groups (P>0.05). The volume of RA in combined-bypass group was larger than that in indirect-bypass group (101.5 ± 35.5 ml vs. 45.3 ± 14.2 ml, P<0.01). In the combined group, 81.4% (57/70) of operated ECA could perfuse deep structures such as basal ganglia and thalamus, compared with 2/14 in the control group (P<0.01). Conclusions The T-ASL results have suggested that RA of combined bypass seems larger and deeper than that of indirect bypass. T-ASL could an objective and sensitive method to evaluate surgical results of adult MMD in terms of RA volume and spatial distribution. Key words: Moyamoya disease; Cerebral revascularization; Territory arterial spin labeling; Treatment outcome

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MRI区域动脉自旋标记评价成年烟雾病患者术后血运重建

目的应用MRI区域动脉自旋标记（T-ASL）技术评价不同手术方法对成人莫亚莫亚病（MMD）患者术后血运重建的影响。方法回顾分析2018年6月至2018年12月在复旦大学华山医院神经外科手术治疗的84例成人MMD患者的临床资料。70例患者接受了颞浅动脉-大脑中动脉搭桥术（STA-MCA搭桥术）联合脑硬肌联合血管病（EDMS），并被分为联合搭桥组。14名患者仅接受EDMS，并被分为间接搭桥组。术前和术后分别行数字减影血管造影术（DSA）和T-ASL。Matsushima分期系统用于评估血运重建的结果。T-ASL扫描用于研究手术侧颈外动脉血运重建区（RA）和脑深部结构的灌注。结果84例患者随访时间4～8个月，平均6.3±1.2个月。基线数据（性别、年龄、临床表现和术前自发性络脉）、围手术期并发症、术后卒中控制率、，松岛期（A级或B级）两组比较（P>0.05）。联合旁路组RA体积大于间接旁路组（101.5±35.5ml vs.45.3±14.2ml，P<0.01）。联合组81.4%（57/70）的手术ECA能灌注基底节、丘脑等深部结构，与对照组2/14比较，差异有统计学意义（P<0.01）。T-ASL可以从RA体积和空间分布的角度评估成人MMD的手术结果，是一种客观而敏感的方法。关键词：莫亚莫亚病；脑血运重建；区域动脉旋转标记；治疗结果

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来源期刊

中华神经外科杂志 Medicine-Surgery

CiteScore

0.10

自引率

0.00%

发文量

10706

期刊介绍： Chinese Journal of Neurosurgery is one of the series of journals organized by the Chinese Medical Association under the supervision of the China Association for Science and Technology. The journal is aimed at neurosurgeons and related researchers, and reports on the leading scientific research results and clinical experience in the field of neurosurgery, as well as the basic theoretical research closely related to neurosurgery.Chinese Journal of Neurosurgery has been included in many famous domestic search organizations, such as China Knowledge Resources Database, China Biomedical Journal Citation Database, Chinese Biomedical Journal Literature Database, China Science Citation Database, China Biomedical Literature Database, China Science and Technology Paper Citation Statistical Analysis Database, and China Science and Technology Journal Full Text Database, Wanfang Data Database of Medical Journals, etc.