Shimizu Tatsuya, Aihara Masanori, Yamaguchi Rei, Aishima Kaoru, Shintoku Ryosuke, Tosaka Masahiko, Yoshimoto Yuhei
Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan..
Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
J Stroke Cerebrovasc Dis. 2023 Jun;32(6):107110. doi: 10.1016/j.jstrokecerebrovasdis.2023.107110. Epub 2023 Apr 4.
To investigate factors associated with improvements in cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) after combined revascularization surgery for moyamoya disease, with special attention to the size of craniotomy.
We retrospectively analyzed 35 hemispheres in 27 patients with adult and older pediatric moyamoya disease. CBF and CVR were measured separately in the MCA and ACA territories from acetazolamide-challenged single-photon emission computed tomography before and after 6 months postoperatively, and associations with various factors were analyzed.
Postoperative CBF improved in patients with lower preoperative blood flow in both ACA and MCA territories. Postoperative CVR improved in 32 of 35 patients (91.4%) in the MCA territory and in 30 of 35 patients (85.7%) in the ACA territory, with more prominent improvement in the MCA territory than in the ACA territory (MCA territory 29.7% vs ACA territory 21.1%, p = 0.015). Craniotomy area did not correlate with postoperative CBF and only MCA territory was associated with good (≥30%) CVR improvement (odds ratio 9.33, 95% confidence interval 1.91-45.6, p = 0.003).
Postoperative CBF improved in adult and older pediatric cases, reflecting preoperative CBF. Postoperative CVR improved in most cases, although the degree of improvement was more prominent in the MCA territory than in the ACA territory, suggesting a contribution of the temporal muscle. Large craniotomy area was not associated with improved blood flow in the ACA territory and should be applied prudently.
探讨烟雾病联合血运重建术后脑血流量（CBF）和脑血管反应性（CVR）改善的相关因素，特别关注开颅手术的大小。
我们回顾性分析了27例成人及大龄儿童烟雾病患者的35个半球。在术后6个月前后，通过乙酰唑胺激发单光子发射计算机断层扫描分别测量大脑中动脉（MCA）和大脑前动脉（ACA）区域的CBF和CVR，并分析其与各种因素的相关性。
术前ACA和MCA区域血流较低的患者术后CBF有所改善。35例患者中，32例（91.4%）的MCA区域术后CVR改善，35例患者中30例（85.7%）的ACA区域术后CVR改善，MCA区域的改善比ACA区域更显著（MCA区域29.7% vs ACA区域21.1%，p = 0.015）。开颅面积与术后CBF无关，只有MCA区域与良好（≥30%）的CVR改善相关（优势比9.33，95%置信区间1.91 - 45.6，p = 0.003）。
成人及大龄儿童病例术后CBF改善，反映术前CBF情况。多数病例术后CVR改善，尽管MCA区域的改善程度比ACA区域更显著，提示颞肌的作用。大的开颅面积与ACA区域血流改善无关，应谨慎应用。
