Department of Neurosurgery, School of Medicine, Iwate Medical University, 2-1-1 Idai-dori, Yahaba, Iwate, 028-3695, Japan.
Neurosurg Rev. 2022 Dec;45(6):3665-3673. doi: 10.1007/s10143-022-01861-w. Epub 2022 Sep 16.
Periventricular anastomosis in moyamoya disease (MMD) is an unusual angiographic finding that arises from perforating arteries such as the lenticulostriate artery (LSA), thalamic artery (THA), and anterior choroidal artery (AChA). This anastomosis is associated with increased hemorrhagic risk in MMD and can be corrected by direct revascularization surgery. The present supplementary analysis on a prospective cohort aimed to elucidate changes in periventricular anastomosis after indirect revascularization surgery alone for adult patients with misery perfusion due to ischemic MMD. Twenty-two patients with misery perfusion in the symptomatic cerebral hemisphere who underwent indirect revascularization surgery alone also underwent six-vessel cerebral angiography via arterial catheterization before and at 6 months after surgery. Before surgery, two patients (9%) had positive periventricular anastomosis from the LSA and another (5%) from the AChA; all three of these periventricular anastomoses regressed after surgery, but these changes were not statistically significant (p = 0.0833). The degree of formation of collateral vessels from the LSA significantly decreased after surgery (p = 0.0143), but the degree of collateral vessels from the THA or AChA did not differ between pre- and postoperative conditions. Eight patients with postoperative regression of the collateral vessels from any perforating artery exhibited postoperative rich collateral flow from indirect revascularization. Periventricular anastomosis tended to regress after indirect revascularization surgery alone for adult patients with misery perfusion due to ischemic MMD. Collateral vessels formed from the LSA likely regressed after indirect revascularization surgery alone for such patients, but those vessels from the THA or AChA seldom changed.
烟雾病（MMD）中的室周吻合是一种不常见的血管造影表现，它源于穿通动脉，如纹状体动脉（LSA）、丘脑动脉（THA）和脉络膜前动脉（AChA）。这种吻合与 MMD 出血风险增加有关，可以通过直接血运重建手术纠正。本前瞻性队列的补充分析旨在阐明单独进行间接血运重建手术治疗因缺血性 MMD 导致的灌注不良的成年患者的室周吻合的变化。22 例症状性大脑半球灌注不良的患者单独接受间接血运重建手术，术前和术后 6 个月均通过动脉导管进行六血管脑血管造影。术前，2 例（9%）患者 LSA 有阳性室周吻合，另 1 例（5%）患者 AChA 有阳性室周吻合；所有这 3 例室周吻合在术后均消退，但这些变化无统计学意义（p=0.0833）。术后，来自 LSA 的侧支血管形成程度显著降低（p=0.0143），但来自 THA 或 AChA 的侧支血管程度在术前和术后无差异。8 例任何穿通动脉侧支血管术后消退的患者，术后均有丰富的间接血运重建的侧支血流。单独进行间接血运重建手术治疗缺血性 MMD 导致的灌注不良的成年患者，室周吻合可能会消退。对于此类患者，单独进行间接血运重建手术后，来自 LSA 的侧支血管可能会消退，但来自 THA 或 AChA 的侧支血管很少发生变化。
