Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-Ku, Hiroshima, 734-8551, Japan.
Department of Clinical Laboratory, Hiroshima University Hospital, Hiroshima, Japan.
Neurosurg Rev. 2023 Oct 17;46(1):274. doi: 10.1007/s10143-023-02181-3.
Transient neurological events (TNEs) occur after bypass surgery in Moyamoya disease (MMD); however, their pathology remains unknown. To elucidate the pathophysiology of TNEs, we investigated their relationship with perioperative superficial temporal artery (STA) blood flow volume, which was evaluated using ultrasonography. Forty-nine patients with MMD, who underwent direct bypass surgery, were included and stratified into TNE and non-TNE groups, respectively. The STA blood flow volume was evaluated at four time points (preoperatively and 2-4, 7, and 10-14 days postoperatively), and a change in volume during the postoperative period was defined as a flow volume mismatch. We investigated the association between ultrasonographic findings of flow volume mismatch and TNEs and magnetic resonance imaging findings, such as the cortical hyperintensity belt (CHB) sign, using univariate and path analyses. The STA blood flow volume increased immediately postoperatively, gradually decreasing over time, in both groups. The TNE group showed a significant increase in blood flow volume 2-4 days postoperatively (P = 0.042). Flow volume mismatch was significantly larger in the TNE group than in the non-TNE group (P = 0.020). In the path analysis, STA flow volume mismatch showed a positive association with the CHB sign (P = 0.023) and TNEs (P = 0.000). Additionally, the CHB sign partially mediated the association between STA flow volume mismatch and TNEs. These results suggest that significantly high STA blood flow volume changes occurring during the acute postoperative period after direct bypass surgery in MMD are correlated with TNEs and the CHB sign, suggesting involvement in the pathophysiology of TNEs.
短暂性神经事件（TNEs）在烟雾病（MMD）旁路手术后发生；然而，其病理仍不清楚。为了阐明 TNEs 的病理生理学，我们研究了它们与围手术期颞浅动脉（STA）血流体积的关系，该体积通过超声评估。49 例接受直接旁路手术的 MMD 患者被纳入并分别分为 TNE 和非 TNE 组。在四个时间点（术前和术后 2-4、7 和 10-14 天）评估 STA 血流体积，并定义术后期间体积的变化为血流体积不匹配。我们使用单变量和路径分析研究了超声血流体积不匹配与 TNE 之间的关系以及磁共振成像（MRI）结果，如皮质高信号带（CHB）征。术后即刻，两组 STA 血流体积均增加，随时间逐渐减少。TNE 组术后 2-4 天血流体积明显增加（P=0.042）。TNE 组的血流体积不匹配明显大于非 TNE 组（P=0.020）。在路径分析中，STA 血流体积不匹配与 CHB 征（P=0.023）和 TNE（P=0.000）呈正相关。此外，CHB 征部分介导了 STA 血流体积不匹配与 TNE 之间的关联。这些结果表明，MMD 直接旁路手术后急性术后期间 STA 血流体积的显著变化与 TNE 和 CHB 征相关，提示其与 TNE 的病理生理学有关。
