1Department of Neurosurgery, Huashan Hospital.
2Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
J Neurosurg. 2018 Sep;129(3):677-683. doi: 10.3171/2017.5.JNS163112. Epub 2017 Oct 20.
OBJECTIVE Although intracranial vessel remodeling has been observed in moyamoya disease, concerns remain regarding the effect of bypass surgery on hemodynamic changes within the internal carotid artery (ICA). The authors aimed to quantify the surgical effect of bypass surgery on bilateral ICAs in moyamoya disease and to estimate pressure drop (PD) along the length of the ICA to predict surgical outcomes. METHODS Records of patients who underwent bypass surgery for treatment of moyamoya disease and in whom flow rates were obtained pre- and postsurgery by quantitative MR angiography were retrospectively reviewed. Quantitative MR angiography and computational fluid dynamics were applied to measure morphological and hemodynamic changes during pre- and postbypass procedures. The results for vessel diameter, volumetric flow, PD, and mean wall shear stress along the length of the ICA were analyzed. Subgroup analysis was performed for the circle of Willis (CoW) configurations. RESULTS Twenty-three patients were included. The PD in ICAs on the surgical side (surgical ICAs) decreased by 21.18% (SD ± 30.1%) and increased by 11.75% (SD ± 28.6%) in ICAs on the nonsurgical side (contralateral ICAs) (p = 0.001). When the PD in contralateral ICAs was compared between patients with a complete or incomplete CoW, the authors found that the PDI in the former group decreased by 2.45% and increased by 20.88% in the latter (p = 0.05). Regression tests revealed that a greater postoperative decrease in PD corresponded to shrinking of ICAs (R = 0.22, p = 0.02). CONCLUSIONS PD may be used as a reliable biomechanical indicator for the assessment of surgical treatment outcomes. The vessel remodeling characteristics of contralateral ICA were related to CoW configurations.
尽管在烟雾病中观察到颅内血管重塑，但对于旁路手术对内颈动脉（ICA）内血流动力学变化的影响仍存在担忧。作者旨在量化旁路手术对烟雾病双侧 ICA 的手术效果，并估计 ICA 长度上的压力降（PD）以预测手术结果。
回顾性分析了接受旁路手术治疗烟雾病且术前和术后通过定量磁共振血管造影术获得流量的患者记录。应用定量磁共振血管造影术和计算流体动力学来测量旁路手术前后血管形态和血流动力学的变化。分析了血管直径、容积流量、PD 和 ICA 长度上的平均壁切应力的结果。对 Willis 环（CoW）构型进行了亚组分析。
共纳入 23 例患者。手术侧 ICA 的 PD 降低了 21.18%（SD ± 30.1%），对侧 ICA 的 PD 增加了 11.75%（SD ± 28.6%）（p = 0.001）。当比较 CoW 完全或不完全的患者对侧 ICA 的 PD 时，作者发现前者的 PD 降低了 2.45%，后者的 PD 增加了 20.88%（p = 0.05）。回归检验显示，术后 PD 下降幅度越大，ICA 收缩越明显（R = 0.22，p = 0.02）。
PD 可用作评估手术治疗效果的可靠生物力学指标。对侧 ICA 的血管重塑特征与 CoW 构型有关。
