Department of Neurosurgery, Wuhan Medical and Health Center for Women and Children, Wuhan, China.
Cerebrovasc Dis. 2013;35(5):455-60. doi: 10.1159/000350197. Epub 2013 May 31.
The best strategy to assess the changes in brain hemodynamics following superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in patients with Moyamoya disease remains unknown. The purpose of the present study was to assess cerebral hemodynamics using perfusion-weighted magnetic resonance imaging (PWI) before and after STA-MCA bypass surgery in patients with Moyamoya disease.
STA-MCA bypass surgeries were performed on 23 symptomatic cerebral hemispheres in 21 patients (11 females/10 males, age 11-62 years) with Moyamoya disease due to cerebral ischemic attacks or intracranial hemorrhages. Brain PWI images were obtained in the frontal lobes, the temporal lobes, the occipital lobes, and the basal ganglia before and after STA-MCA bypass surgery. The relative parameters cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) derived from PWI were calculated. All patients underwent CT angiography or MR angiography after surgery in order to confirm the patency of bypass.
According to preoperative PWI, there was significant hypoperfusion in the symptomatic temporal and frontal lobes. According to postoperative PWI, the regional CBF had increased in both the temporal and frontal lobes on the operative side (p < 0.05, versus preoperative data). In the postoperative CBV maps, there was a significant decrease in the occipital lobe on the operative side (p < 0.05, versus preoperative data). The postoperative MTT in the temporal lobe, frontal lobe and basal ganglia area on the operative side was short, relative to the preoperative MTT (p < 0.05). The CT angiography or MR angiography imaging demonstrated patency of the bypass in all patients after surgery. During the follow-up period, all patients showed significant improvement in neurological function postoperatively.
This study demonstrates that STA-MCA bypass is a safe and effective surgical treatment for Moyamoya disease. PWI enables an effective and objective assessment of hemodynamics before and after STA-MCA bypass surgery in patients with Moyamoya disease.
评估烟雾病患者颞浅动脉（STA）-大脑中动脉（MCA）旁路手术后脑血流动力学变化的最佳策略仍不清楚。本研究旨在评估烟雾病患者 STA-MCA 旁路手术后使用灌注加权磁共振成像（PWI）评估脑血流动力学。
21 例（11 例女性/10 例男性，年龄 11-62 岁）因脑缺血发作或颅内出血而导致烟雾病的患者，共 23 个症状性大脑半球接受了 STA-MCA 旁路手术。在 STA-MCA 旁路手术后，获得额、颞、枕叶和基底节的脑 PWI 图像。从 PWI 中计算出相对参数脑血流量（CBF）、脑血容量（CBV）和平均通过时间（MTT）。所有患者术后均行 CT 血管造影或 MR 血管造影，以确认旁路的通畅性。
根据术前 PWI，症状性颞叶和额叶存在明显的灌注不足。根据术后 PWI，手术侧颞叶和额叶的区域性 CBF 增加（p<0.05，与术前数据相比）。在术后 CBV 图中，手术侧枕叶的 CBV 明显下降（p<0.05，与术前数据相比）。手术侧颞叶、额叶和基底节区的术后 MTT 较术前 MTT 缩短（p<0.05）。所有患者术后 CT 血管造影或 MR 血管造影均显示旁路通畅。在随访期间，所有患者术后神经功能均有显著改善。
本研究表明，STA-MCA 旁路是烟雾病的一种安全有效的手术治疗方法。PWI 能够有效地、客观地评估烟雾病患者 STA-MCA 旁路手术后的血流动力学变化。
