From the Departments of Neurosurgery (T.F., A.M., K.Y., T.K., Y.M., M.O., Y.Y., S.M.)
From the Departments of Neurosurgery (T.F., A.M., K.Y., T.K., Y.M., M.O., Y.Y., S.M.).
AJNR Am J Neuroradiol. 2022 Sep;43(9):1279-1285. doi: 10.3174/ajnr.A7609. Epub 2022 Aug 25.
Choroidal anastomosis, a hemorrhage-prone periventricular collateral manifestation in Moyamoya disease, outflows to the cortex posterior to the central sulcus. The objective of the present study was to test whether the angiographic extent of revascularization posterior to the central sulcus contributes to the postoperative reduction of choroidal anastomosis.
This retrospective cohort study included choroidal anastomosis-positive hemispheres before direct bypass surgery. The postoperative reduction of choroidal anastomosis was determined by a consensus of 2 raters according to the previous research. An imaging software automatically traced the angiographic revascularization area, which was subsequently divided into anterior and posterior parts by an anatomic line corresponding to the central sulcus. Each area was quantitatively measured as a percentage relative to the whole supratentorial area.
Postoperative reduction of choroidal anastomosis was achieved in 68 (85.0%) of the 80 included hemispheres. The revascularization area posterior to the central sulcus was significantly larger in the hemispheres with reduction than in those with no reduction (mean, 15.2% [SD, 7.1%] versus 4.2% [SD, 3.4%], < .001), whereas no significant difference was observed in the revascularization area anterior to the central sulcus. Multivariate analysis revealed that the revascularization area posterior to the central sulcus was the only significant factor associated with reduction (OR, 1.57; 95% CI, 1.21-2.03, for every 1% increase).
The results suggest that a larger revascularization posterior to the central sulcus is associated with postoperative reduction of choroidal anastomosis regardless of the extent of anterior revascularization. It might facilitate optimal selection of the revascularization site for preventing hemorrhage.
脉络膜吻合是烟雾病脑室周围易出血的侧支表现，可向中央沟后皮质流出。本研究旨在测试中央沟后侧的血管重建程度是否有助于术后脉络膜吻合的减少。
本回顾性队列研究纳入了直接旁路手术前脉络膜吻合阳性的半球。根据之前的研究，由 2 位评分者达成共识确定脉络膜吻合的术后减少程度。成像软件自动追踪血管造影再血管化区域，随后通过与中央沟相对应的解剖线将其分为前、后两部分。将每个区域相对于整个颅顶区域的定量测量表示为百分比。
在纳入的 80 个半球中，有 68 个（85.0%）实现了脉络膜吻合的术后减少。与无减少的半球相比，中央沟后侧的再血管化区域在减少的半球中明显更大（平均 15.2%[SD，7.1%]与 4.2%[SD，3.4%]，<.001），而中央沟前侧的再血管化区域无显著差异。多变量分析显示，中央沟后侧的再血管化区域是与减少相关的唯一显著因素（OR，1.57；95%CI，1.21-2.03，每增加 1%）。
结果表明，中央沟后侧更大的再血管化与术后脉络膜吻合的减少有关，而与前侧再血管化的程度无关。这可能有助于选择最佳的再血管化部位以预防出血。
