Serrone Joseph C, Jimenez Lincoln, Hanseman Dennis J, Carroll Christopher P, Grossman Aaron W, Wang Lily, Vagal Achala, Choutka Ondrej, Andaluz Norberto, Ringer Andrew J, Abruzzo Todd, Zuccarello Mario
Departments of Neurosurgery, UC College of Medicine, Cincinnati, Ohio, United States.
Department of Surgery, Division of Trauma/Critical Care, University of Cincinnati, Cincinnati, Ohio, United States.
J Neurol Surg B Skull Base. 2014 Dec;75(6):371-7. doi: 10.1055/s-0034-1373658. Epub 2014 May 27.
Introduction Analysis of computed tomography perfusion (CTP) studies before and after superficial temporal artery to middle cerebral artery (STA-MCA) bypass is warranted to better understand cerebral steno-occlusive pathology. Methods Retrospective review was performed of STA-MCA bypass patients with steno-occlusive disease with CTP before and after surgery. CTP parameters were evaluated for change after STA-MCA bypass. Results A total of 29 hemispheres were bypassed in 23 patients. After STA-MCA bypass, mean transit time (MTT) and time to peak (TTP) improved. When analyzed as a ratio to the contralateral hemisphere, MTT, TTP, and cerebral blood flow (CBF) improved. There was no effect of gender, double vessel versus single vessel bypass, or time until postoperative CTP study to changes in CTP parameters after bypass. Conclusions Blood flow augmentation after STA-MCA bypass may best be assessed by CTP using baseline MTT or TTP and ratios of MTT, TTP, or CBF to the contralateral hemisphere. The failure of cerebrovascular reserve to improve after cerebral bypass may indicate irreversible loss of autoregulation with chronic cerebral vasodilation or the inability of CTP to detect these improvements.
颞浅动脉-大脑中动脉（STA-MCA）搭桥术前和术后进行计算机断层扫描灌注（CTP）研究分析，有助于更好地了解脑狭窄闭塞性病变。方法：对患有狭窄闭塞性疾病的STA-MCA搭桥患者进行回顾性研究，记录其手术前后的CTP情况。评估STA-MCA搭桥术后CTP参数的变化。结果：23例患者共29个半球接受了搭桥手术。STA-MCA搭桥术后，平均通过时间（MTT）和达峰时间（TTP）有所改善。以与对侧半球的比值进行分析时，MTT、TTP和脑血流量（CBF）均有所改善。性别、双血管与单血管搭桥，以及术后CTP研究时间对搭桥术后CTP参数变化均无影响。结论：STA-MCA搭桥术后血流增加情况，最好通过CTP使用基线MTT或TTP以及MTT、TTP或CBF与对侧半球的比值来评估。脑血管搭桥术后脑血管储备未能改善，可能表明慢性脑血管扩张导致自动调节功能不可逆转地丧失，或者CTP无法检测到这些改善。
