Department of Neurosurgery, Peking University International Hospital, Peking University, Zhongguancun Life Science Park Garden Road No. 1, Changping District, Beijing, 102206, People's Republic of China.
Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, Southwestern 4th Ring Road, Fengtai District, Beijing, 100070, People's Republic of China.
Neurosurg Rev. 2021 Oct;44(5):2659-2666. doi: 10.1007/s10143-020-01442-9. Epub 2020 Nov 26.
Direct bypass surgery improves blood flow in patients with moyamoya disease (MMD) as well as causes local flow relocation and disturbance. This study aimed to describe the characteristics and changes of quantitative blood flow in MMD patients. Sixty-four consecutive MMD patients (67 hemispheres) who underwent STA-MCA anastomosis between August 2013 and September 2017 were included in this study. Intraoperative blood flow of superficial temporal artery and middle cerebral artery was measured with a noninvasive, ultrasound flowprobe, before and after the bypass. All data were collected prospectively. Before the bypass, 67 hemispheres were measured and 45 hemispheres acquired post-bypass measurements. Thirty-three (49.3%) had anterograde flow and 34 (50.7%) had retrograde. Retrograde blood flow was significantly higher than anterograde blood flow in MCA-M4 section (3.71 ± 2.78 ml/min vs 2.39 ± 1.71 ml/min, P = 0.023). Thirty-eight (56.7%) patients had local cerebrovascular reactivity, whereas 29 (43.3%) lost it. After bypass, blood flow was changed into three patterns: anterograde flow (1, 2.2%), retrograde flow (3, 6.7%), and bi-direction flow (41, 91.1%). Flow of M4 was significantly improved in both proximal (13.64 ± 9.16 vs 3.28 ± 2.57, P < 0.001) and distal (7.17 ± 7.21 vs 3.28 ± 2.57, P = 0.002) sides to the bypass. Postoperative infarctions occurred in 4 (8.9%) patients. All postoperative infarctions (n = 4) happened in those patients who did not have change of flow direction in M4 section distal to the bypass (P = 0.040). Direct bypass surgery improves local blood flow after bypass surgery in both sides of the anastomosis. Flow direction was usually changed after the surgery into a bi-direction pattern: anterograde flow in M4 distal to the bypass, and retrograde flow in M4 proximal to the bypass. Proximal side acquired around 5.4 times of flow than the distal side. Patients with change of flow direction in distal M4 were related with lower risks of postoperative infarctions.
直接旁路手术可改善烟雾病（MMD）患者的血流，同时引起局部血流重新分布和干扰。本研究旨在描述 MMD 患者定量血流的特征和变化。
2013 年 8 月至 2017 年 9 月期间，64 例连续 MMD 患者（67 侧半球）接受了 STA-MCA 吻合术，纳入本研究。在旁路手术前后，使用非侵入性超声探头测量颞浅动脉和大脑中动脉的术中血流。所有数据均前瞻性收集。旁路手术前测量了 67 侧半球，旁路手术后测量了 45 侧半球。33 例（49.3%）为顺行血流，34 例（50.7%）为逆行血流。MCA-M4 段的逆行血流明显高于顺行血流（3.71±2.78ml/min 比 2.39±1.71ml/min，P=0.023）。38 例（56.7%）患者存在局部脑血管反应性，29 例（43.3%）患者失去了这种反应性。旁路手术后，血流分为三种模式：顺行血流（1 例，2.2%）、逆行血流（3 例，6.7%）和双向血流（41 例，91.1%）。吻合口近端（13.64±9.16 比 3.28±2.57，P<0.001）和远端（7.17±7.21 比 3.28±2.57，P=0.002）的 M4 血流均明显改善。4 例（8.9%）患者术后发生梗死。所有术后梗死（n=4）均发生在那些吻合口远端 M4 段血流方向无变化的患者中（P=0.040）。
直接旁路手术可改善吻合口两侧的局部术后血流。术后血流方向通常变为双向模式：吻合口远端 M4 顺行血流，吻合口近端 M4 逆行血流。吻合口近端获得的血流约为远端的 5.4 倍。吻合口远端 M4 血流方向发生变化的患者术后梗死风险较低。
