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Hemodynamic improvement of anterior cerebral artery territory perfusion induced by bifrontal encephalo(periosteal)synangiosis in pediatric patients with moyamoya disease: a study with brain perfusion SPECT

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Abstract

Objective

The reinforcement of the anterior cerebral artery (ACA) territory perfusion is important for the future intellectual functioning of pediatric moyamoya disease (MMD) patients. To evaluate the hemodynamic improvement of the ACA territory, bifrontal encephalogaleo-(periosteal)synangiosis [EG(P)S] combined with encephaloduroarteriosynangiosis (EDAS) was compared with EDAS alone in pediatric MMD patients using brain perfusion SPECT.

Methods

Among 36 patients (M:F = 16:20; mean age, 9.5 ± 3.0 years) who were surgically treated for MMD, EDAS was performed in 17 patients, and EDAS with bifrontal EG(P)S in 19 patients. Hemodynamic parameters consisting of basal cerebral perfusion, acetazolamide-challenge stress perfusion, and cerebrovascular reserve index were estimated using brain perfusion SPECT and probabilistic perfusion maps for the ACA and middle cerebral artery (MCA) territories. Cerebral angiography was performed to confirm revascularization.

Results

Both the EDAS only (p = 0.04) and EDAS with EG(P)S group (p < 0.001) had significant improvements in cerebrovascular reserve of the ipsilateral MCA territory. The EDAS with EG(P)S group had significant improvements, not only in basal perfusion of the ipsilateral ACA territory (p = 0.03) but also in the cerebrovascular reserve of the bilateral ACA territories (p < 0.01). In parallel with the hemodynamic changes assessed by brain perfusion SPECT, neovascularization was noted in the ipsilateral MCA territory in both the EDAS only and EDAS with EG(P)S group, and in the ipsilateral ACA territory in the EDAS with EG(P)S group on the postoperative cerebral angiography.

Conclusions

EDAS with bifrontal EG(P)S induces significant improvements in the ACA and MCA territories, while EDAS generates significant improvements in the MCA territory only.

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Acknowledgments

This study was funded by the Brain Research Center of the 21st Century Frontier Research Program (2009K001257); the WCU project of the MEST and the NRF (R31-2008-000-10103-0); and the Korea Healthcare technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A080588-26, S-K. K).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehang-ro, Jongno-gu, Seoul, 110-744, Korea

    Yoo Sung Song, So Won Oh, Yu Keong Kim & Dong Soo Lee

  2. Department of Nuclear Medicine, Seoul National University Boramae Medical Center, Seoul, Korea

    So Won Oh

  3. Division of Pediatric Neurosurgery, Seoul National University College of Medicine, Seoul, Korea

    Seung-Ki Kim & Kyu-Chang Wang

  4. Department of Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea

    Dong Soo Lee

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  1. Yoo Sung Song
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Correspondence to So Won Oh or Dong Soo Lee.

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Song, Y.S., Oh, S.W., Kim, Y.K. et al. Hemodynamic improvement of anterior cerebral artery territory perfusion induced by bifrontal encephalo(periosteal)synangiosis in pediatric patients with moyamoya disease: a study with brain perfusion SPECT. Ann Nucl Med 26, 47–57 (2012). https://doi.org/10.1007/s12149-011-0541-8

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  • DOI: https://doi.org/10.1007/s12149-011-0541-8

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