Tanabe Nozomu, Yamamoto Shusuke, Kashiwazaki Daina, Akioka Naoki, Kuwayama Naoya, Noguchi Kyo, Kuroda Satoshi
Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
Department of Radiology, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan.
Acta Neurochir (Wien). 2017 Mar;159(3):567-575. doi: 10.1007/s00701-016-3060-5. Epub 2017 Jan 3.
The middle meningeal artery (MMA) is well known to function as an important collateral channel to the territory of the anterior cerebral artery in moyamoya disease. This study was aimed to evaluate whether indocyanine green (ICG) videoangiography could visualize the anterior branch of the MMA before craniotomy during surgical revascularization for moyamoya disease.
This study included 19 patients who developed TIA, ischemic stroke or hemorrhagic stroke due to moyamoya disease. Plain CT scan and three-dimensional time-of-flight MR angiography were performed in all patients before surgery. All of them underwent superficial temporal artery to middle temporal artery anastomosis and indirect bypass on 27 sides in total.
ICG videoangiography could clearly visualize the anterior branch of the MMA in 10 (37%) of 27 sides. The patients with a "visible" MMA are significantly younger than those without. Radiological analysis revealed that ICG videoangiography could visualize it through the cranium when the diameter of the MMA is >1.3 mm and the sphenoid bone thickness over the MMA is <3.0 mm. The MMA could be preserved during craniotomy in all "visible" MMAs, but not in 4 (23.5%) of 17 "invisible" MMAs. The results strongly suggest that ICG videoangiography can visualize the anterior branch of the MMA before craniotomy in about one-third of patients with a large-diameter MMA (>1.3 mm) and thin sphenoid bone (<3.0 mm).
ICG videoangiography is a safe and valuable technique to preserve the anterior branch of the MMA during craniotomy for moyamoya disease.
在烟雾病中，脑膜中动脉（MMA）是大脑前动脉供血区域的重要侧支通道，这一点广为人知。本研究旨在评估吲哚菁绿（ICG）血管造影术能否在烟雾病手术血运重建开颅术前显示MMA的前支。
本研究纳入了19例因烟雾病发生短暂性脑缺血发作（TIA）、缺血性卒中或出血性卒中的患者。所有患者在手术前均进行了平扫CT扫描和三维时间飞跃磁共振血管造影。他们全部接受了颞浅动脉-颞中动脉吻合术及间接搭桥术，共27侧。
ICG血管造影术能够在27侧中的10侧（37%）清晰显示MMA的前支。MMA“可见”的患者明显比MMA“不可见”的患者年轻。影像学分析显示，当MMA直径>1.3mm且MMA上方蝶骨厚度<3.0mm时，ICG血管造影术可透过颅骨显示MMA。在所有MMA“可见”的病例中，开颅手术时MMA均可保留，但在17例MMA“不可见”的病例中有4例（23.5%）无法保留。结果强烈提示，对于约三分之一MMA直径较大（>1.3mm）且蝶骨较薄（<3.0mm）的烟雾病患者，ICG血管造影术可在开颅术前显示MMA的前支。
ICG血管造影术是烟雾病开颅手术中保留MMA前支的一种安全且有价值的技术。
