Ishii Daizo, Maeda Yuyo, Kuwabara Masashi, Hosogai Masahiro, Kume Shinji, Hara Takeshi, Kondo Hiroshi, Horie Nobutaka
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
J Stroke Cerebrovasc Dis. 2023 Nov;32(11):107346. doi: 10.1016/j.jstrokecerebrovasdis.2023.107346. Epub 2023 Sep 12.
Direct bypass surgery by superficial temporal artery (STA) - middle cerebral artery anastomosis is an established procedure for moyamoya disease (MMD). However, some patients may develop cerebral infarction (CI) due to the watershed shift phenomenon after the surgery. This study sought to investigate the correlation between the postoperative changes of STA flow as well as cerebral blood flow (CBF) and the incidence of CI after direct bypass surgery for MMD.
We conducted a retrospective study of 62 hemispheres in 50 subjects who underwent direct bypass surgery for MMD. All subjects underwent pre- and post-operative MR imaging, ultrasound evaluation of STA, and single-photon emission computed tomography. The presence of CI was correlated with preoperative CBF, the delta difference of each value of the STA between before and after the surgery, and the postoperative increase ratio of CBF.
All bypass procedures were patent, and CI was observed in 4 cases (6.4%). There was no significant association between the incidence of CI and both pre- and post-operative CBF. However, there was a significant difference in delta pulsatility index (PI) of the STA between cases with or without CI (-0.38±0.22 and -0.87±0.63, respectively, p=0.03). Whereas, other factors did not show any significant differences between those with or without CI.
A relatively high postoperative PI of the STA was significantly associated with the incidence of CI after direct bypass surgery for MMD. A larger study is needed to confirm these findings.
颞浅动脉（STA）-大脑中动脉吻合直接搭桥手术是烟雾病（MMD）的一种既定术式。然而，部分患者术后可能因分水岭转移现象而发生脑梗死（CI）。本研究旨在探讨MMD直接搭桥手术后STA血流及脑血流量（CBF）的术后变化与CI发生率之间的相关性。
我们对50例接受MMD直接搭桥手术的受试者的62个半球进行了回顾性研究。所有受试者均接受了术前和术后的磁共振成像、STA超声评估以及单光子发射计算机断层扫描。CI的发生与术前CBF、手术前后STA各值的差值以及术后CBF增加率相关。
所有搭桥手术均通畅，4例（6.4%）观察到CI。CI发生率与术前和术后CBF均无显著相关性。然而，有CI和无CI病例之间STA的搏动指数（PI）差值存在显著差异（分别为-0.38±0.22和-0.87±0.63，p = 0.03）。而其他因素在有CI和无CI患者之间未显示出任何显著差异。
STA术后相对较高的PI与MMD直接搭桥手术后CI的发生率显著相关。需要更大规模的研究来证实这些发现。
