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Acta Neurochirurgica

, Volume 161, Issue 5, pp 947–954 | Cite as

Restoration of periventricular vasculature after direct bypass for moyamoya disease: intra-individual comparison

  • Akinori Miyakoshi
  • Takeshi FunakiEmail author
  • Jun C Takahashi
  • Yasushi Takagi
  • Takayuki Kikuchi
  • Kazumichi Yoshida
  • Hiroharu Kataoka
  • Yohei Mineharu
  • Masakazu Okawa
  • Yukihiro Yamao
  • Yasutaka Fushimi
  • Tomohisa Okada
  • Kaori Togashi
  • Susumu Miyamoto
Original Article - Vascular Neurosurgery - Other
Part of the following topical collections:
  1. Vascular Neurosurgery – Other

Abstract

Background

While periventricular anastomosis, a unique abnormal vasculature in moyamoya disease, has been studied in relation to intracranial hemorrhage, no study has addressed its change after bypass surgery. The authors sought to test whether direct bypass surgery could restore normal periventricular vasculature.

Methods

Patients who had undergone direct bypass surgery for moyamoya disease at a single institution were eligible for the study. Baseline, postoperative, and follow-up magnetic resonance angiography (MRA) scans were scheduled before surgery, after the first surgery, and 3 to 6 months after contralateral second surgery, respectively. Sliding-thin-slab maximum-intensity-projection coronal MRA images of periventricular anastomoses were scored according to the three subtypes (lenticulostriate, thalamic, and choroidal anastomosis). Baseline and postoperative MRA images were compared to obtain a matched comparison of score changes in the surgical and nonsurgical hemispheres within individuals (intra-individual comparison).

Results

Of 110 patients, 42 were identified for intra-individual comparisons. The periventricular anastomosis score decreased significantly in the surgical hemispheres (median, 2 versus 1; p < 0.001), whereas the score remained unchanged in the nonsurgical hemispheres (median, 2 versus 2; p = 0.57); the score change varied significantly between the surgical and nonsurgical hemispheres (p < 0.001). Of the 104 periventricular-anastomosis-positive hemispheres undergoing surgery, 47 (45.2%) were assessed as negative in the follow-up MRA. Among the subtypes, choroidal anastomosis was most likely to be assessed as negative (79.7% of positive hemispheres).

Conclusions

Periventricular vasculature can be restored after direct bypass. The likelihood of correction of choroidal anastomosis is a subject requiring further studies.

Keywords

Moyamoya disease Intracranial hemorrhage Cerebral revascularization Periventricular anastomosis 

Abbreviations

MCA

Middle cerebral artery

MRA

Magnetic resonance angiography

PCA

Posterior cerebral artery

SPECT

Single photon emission tomography

STA

Superficial temporal artery

STS-MIP

Sliding-thin-slab maximum-intensity-projection

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

All subjects gave opt-out consent.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Akinori Miyakoshi
    • 1
  • Takeshi Funaki
    • 1
    Email author
  • Jun C Takahashi
    • 2
  • Yasushi Takagi
    • 3
  • Takayuki Kikuchi
    • 1
  • Kazumichi Yoshida
    • 1
  • Hiroharu Kataoka
    • 1
  • Yohei Mineharu
    • 1
  • Masakazu Okawa
    • 1
  • Yukihiro Yamao
    • 1
  • Yasutaka Fushimi
    • 4
  • Tomohisa Okada
    • 5
  • Kaori Togashi
    • 4
  • Susumu Miyamoto
    • 1
  1. 1.Department of NeurosurgeryKyoto University Graduate School of MedicineKyotoJapan
  2. 2.Department of NeurosurgeryNational Cerebral and Cardiovascular CenterOsakaJapan
  3. 3.Department of NeurosurgeryTokushima University Graduate School of Biomedical SciencesTokushimaJapan
  4. 4.Department of Diagnostic Imaging and Nuclear MedicineKyoto University Graduate School of MedicineKyotoJapan
  5. 5.Department of Human Brain Research CenterKyoto University Graduate School of MedicineKyotoJapan

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