Ishii Yosuke, Tanaka Yoji, Momose Toshiya, Yamashina Motoshige, Sato Akihito, Wakabayashi Shinichi, Maehara Taketoshi, Nariai Tadashi
Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan; Department of Radiology, Stanford University, California, USA.
Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
World Neurosurg. 2017 Dec;108:427-435. doi: 10.1016/j.wneu.2017.09.001. Epub 2017 Sep 8.
Although indirect bypass surgery is an effective treatment option for patients with ischemic-onset moyamoya disease (MMD), the time point after surgery at which the patient's hemodynamic status starts to improve and the time point at which the improvement reaches a maximum have not been known. The objective of the present study is to evaluate the hemodynamic status time course after indirect bypass surgery for MMD, using dynamic susceptibility contrast-magnetic resonance imaging (DSC-MRI).
We retrospectively analyzed the cases of 25 patients with MMD (37 sides; mean age, 14.7 years; range, 3-36 years) who underwent indirect bypass surgery and repeated DSC-MRI measurement within 6 months after the operation. The difference in the mean transit time (MTT) between the target regions and the control region (cerebellum) was termed the MTT delay, and we measured the MTT delay's chronologic changes after surgery.
The postoperative MTT delay was 1.81 ± 1.16 seconds within 1 week after surgery, 1.57 ± 1.01 at weeks 1-2, 1.55 ± 0.68 at weeks 2-4, 1.32 ± 0.68 at months 1-2, 0.95 ± 0.32 at months 2-3, and 0.77 ± 0.33 at months 3-6. Compared with the preoperative value (2.11 ± 0.98 seconds), the MTT delay decreased significantly from 2 to 4 weeks after surgery (P < 0.05).
The amelioration of cerebral hemodynamics by indirect bypass surgery began soon after surgery and gradually reached a maximum at 3 months after surgery. DSC-MRI detected small changes in hemodynamic improvement, which are suspected to be caused by the initiation of angiogenesis and arteriogenesis in the early postoperative period.
尽管间接搭桥手术是缺血型烟雾病（MMD）患者的一种有效治疗选择，但术后患者血流动力学状态开始改善的时间点以及改善达到最大值的时间点尚不清楚。本研究的目的是使用动态磁敏感对比磁共振成像（DSC-MRI）评估MMD间接搭桥手术后的血流动力学状态时间进程。
我们回顾性分析了25例接受间接搭桥手术并在术后6个月内重复进行DSC-MRI测量的MMD患者（37侧；平均年龄14.7岁；范围3-36岁）的病例。将目标区域与对照区域（小脑）之间的平均通过时间（MTT）差异称为MTT延迟，我们测量了术后MTT延迟的时间变化。
术后1周内MTT延迟为1.81±1.16秒，1-2周时为1.57±1.01秒，2-4周时为1.55±0.68秒，1-2个月时为1.32±0.68秒，2-3个月时为0.95±0.32秒，3-6个月时为0.77±0.33秒。与术前值（2.11±0.98秒）相比，术后2至4周MTT延迟显著降低（P<0.05）。
间接搭桥手术对脑血流动力学的改善在术后不久就开始，并在术后3个月逐渐达到最大值。DSC-MRI检测到血流动力学改善的微小变化，怀疑是由术后早期血管生成和动脉生成的启动引起的。
