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

  • Original Article - Vascular Neurosurgery - Other
  • Published:
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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.

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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

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Authors and Affiliations

  1. Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan

    Akinori Miyakoshi, Takeshi Funaki, Takayuki Kikuchi, Kazumichi Yoshida, Hiroharu Kataoka, Yohei Mineharu, Masakazu Okawa, Yukihiro Yamao & Susumu Miyamoto

  2. Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan

    Jun C Takahashi

  3. Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

    Yasushi Takagi

  4. Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Yasutaka Fushimi & Kaori Togashi

  5. Department of Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Tomohisa Okada

Authors
  1. Akinori Miyakoshi
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  2. Takeshi Funaki
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  3. Jun C Takahashi
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  4. Yasushi Takagi
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  5. Takayuki Kikuchi
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  6. Kazumichi Yoshida
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  7. Hiroharu Kataoka
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  8. Yohei Mineharu
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  10. Yukihiro Yamao
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  11. Yasutaka Fushimi
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  12. Tomohisa Okada
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  13. Kaori Togashi
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  14. Susumu Miyamoto
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Corresponding author

Correspondence to Takeshi Funaki.

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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.

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Comments

In this study, the authors used MRA to evaluate the periventricular anastomosis in patients with moyamoya disease and score the changes after direct bypass surgery including intra-individual comparison. The study nicely demonstrated the beneficial effect of direct EC-IC bypass on periventricular anastomosis in patients with moyamoya disease. This effect has long been purported to occur and described anecdotally, but this is the first study to demonstrate this effect as related to direct bypass surgery. Further work aiming to elucidate the factors influencing the degree of improvement would be welcome. For example, measuring flow in the bypass during surgery and afterwards and determining whether a robust bypass with greater flow augmentation, might be a factor, would be of great value. Also, longer term correlation of the changes in anastomosis patterns with the risk of bleeding and outcomes would be most welcome. But for the time being, the authors are to be congratulated on this novel work which nicely adds to our understanding of this elusive disease.

Fady Charbel

Illinois, USA

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This article is part of the Topical Collection on Vascular Neurosurgery - Other

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Miyakoshi, A., Funaki, T., Takahashi, J.C. et al. Restoration of periventricular vasculature after direct bypass for moyamoya disease: intra-individual comparison. Acta Neurochir 161, 947–954 (2019). https://doi.org/10.1007/s00701-019-03866-9

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  • DOI: https://doi.org/10.1007/s00701-019-03866-9

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