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Decreased cortical perfusion in areas with blood-brain barrier dysfunction in Moyamoya disease

  • Original Article - Vascular Neurosurgery - Ischemia
  • Published:
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Abstract

Background

Recently, several studies have focused on the relationship between blood-brain barrier (BBB) impairment and the etiology of Moyamoya disease (MMD). However, in vivo studies investigating about BBB impairment and cortical perfusion in MMD patients were really rare.

Methods

This study included 16 patients diagnosed with MMD and 9 patients with atherosclerotic cerebrovascular disease (ACVD); all of who were treated with superficial temporal artery–middle cerebral artery (STA-MCA) bypass. Cortical perfusion was assessed using intraoperative indocyanine green (ICG) videoangiography by calculating the blood flow index (BFI). In addition, we used sodium fluorescein (NaFl) to evaluate the permeability of BBB in vivo during operation.

Results

The results showed that BBB impairment in MMD patients was more significant than that in ACVD patients, whereas, the cortical perfusion was comparable between two groups. BFI was significantly improved after STA-MCA bypass both in the MMD group (post-operation vs pre-operation: 109.2 ± 67.7 vs 64.3 ± 35.0, p = 0.004) and the ACVD group (post-operation vs pre-operation: 137.6 ± 89.6 vs 90.8 ± 58.3, p = 0.015). Moreover, BFI was significantly decreased in the cortex with BBB impairment as compared with that in the cortex with intact BBB (impaired BBB vs intact BBB: 55.7 ± 26.5 vs 87.6 ± 55.1, p = 0.025). Following bypass, the cortical perfusion significantly improved in the area of BBB impairment (post-operation vs pre-operation: 93.8 ± 75.2 vs 55.7 ± 26.5, p = 0.004), which was not observed in the BBB intact area (post-operation vs pre-operation: 92.4 ± 50.4 vs 87.6 ± 55.1, p = 0.58).

Conclusion

In summary, we observed that BBB impairment in MMD patients was more significant than that in ACVD patients. This study also demonstrated for the first time that cortical perfusion was significantly decreased in the cortex with BBB impairment as compared with that in the cortex with intact BBB in MMD patients. We also observed that After STA-MCA bypass, the cortical perfusion was significantly improved in the cortex with BBB impairment. These results may provide a new insight for BBB impairment and cortical perfusion in the etiology of MMD.

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Funding

This work was supported by the National Natural Science Foundation of China (No. 81601064).

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Author notes

  1. Xiaocheng Lu and Yabo Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China

    Xiaocheng Lu, Yabo Huang, Peng Zhou, Pinjing Hui & Zhong Wang

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  1. Xiaocheng Lu
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Correspondence to Yabo Huang.

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This protocol was approved by the ethics committee of the First Affiliated Hospital of Soochow University. All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed written consent for this study was obtained for all patients from the patients themselves or their guardians.

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Lu, X., Huang, Y., Zhou, P. et al. Decreased cortical perfusion in areas with blood-brain barrier dysfunction in Moyamoya disease. Acta Neurochir 162, 2565–2572 (2020). https://doi.org/10.1007/s00701-020-04480-w

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  • DOI: https://doi.org/10.1007/s00701-020-04480-w

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