1
|
Kato N, Kan I, Abe Y, Otani K, Narikiyo M, Nagayama G, Nishimura K, Mori R, Kodama T, Ishibashi T, Murayama Y. Visualization of extracranial-intracranial bypass in moyamoya patients using intraoperative three-dimensional digital subtraction angiography with intravenous contrast injection and robotic C-arm: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 1:CASE2057. [PMID: 36131586 PMCID: PMC9628098 DOI: 10.3171/case2057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/19/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND The authors describe a noninvasive intraoperative imaging strategy of three-dimensional (3D) digital subtraction angiography (DSA) with intravenous (IV) contrast injection, using indocyanine green (ICG) as a test bolus, during extracranial-intracranial (EC-IC) bypass surgery for moyamoya disease. OBSERVATIONS Four patients underwent EC-IC bypass surgery in a hybrid operating room. During the surgery, bypass patency was verified using ICG videoangiography and Doppler ultrasonography. After skin closure, the patients under anesthesia underwent IV 3D-DSA with a robotic C-arm in which the scan delay time for the 3D-DSA scan was estimated from the arrival time of ICG during the ICG videoangiography. One day after the surgery, the patients underwent magnetic resonance angiography (MRA). The IV 3D-DSA images were retrospectively compared with those obtained with other modalities. Good bypass patency was confirmed on IV 3D-DSA, ICG videoangiography, Doppler ultrasonography, and postoperative MRA in all cases. The delay time determined using ICG videoangiography as a test bolus resulted in IV 3D-DSA with adequate image quality, allowing assessment of the spatial relationships between the vessels and anastomoses from all directions. LESSONS To evaluate bypass patency and anatomical relationships immediately after EC-IC bypass surgery, IV 3D-DSA may be a useful modality. ICG videoangiography can be used to determine the scan delay time.
Collapse
Affiliation(s)
- Naoki Kato
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Issei Kan
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Yukiko Abe
- Department of Radiology, The Jikei University Hospital, Tokyo, Japan
| | - Katharina Otani
- Siemens Healthcare K.K., Advanced Therapies Innovation Department, Tokyo, Japan; and
| | - Michihisa Narikiyo
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | - Gota Nagayama
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Kengo Nishimura
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Ryosuke Mori
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Tomonobu Kodama
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| |
Collapse
|
2
|
Wang G, Zhang X, Wang B, Wen Y, Chen S, Liu J, Ke B, Wu H, Zhang G, Li M, Zhang S, Ji L, Li Y, Qi S, Feng W. Flow evaluation of STA-MCA bypass using quantitative ultrasonography: An alternative to standard angiography for follow up of bypass graft. J Stroke Cerebrovasc Dis 2020; 29:105000. [PMID: 32807419 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/10/2020] [Accepted: 05/23/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To date, digital subtraction angiography (DSA) has been considered as the gold imaging modality for assessing graft patency after extracranial-intracranial bypass. The utility of a noninvasive and quantitative method of assessing graft flow postoperatively was evaluated by using quantitative ultrasonography. METHOD All STA-MCA bypass surgery performed over a 5-year period at a single institution were reviewed. Measured by duplex ultrasonography, pre-operative (day1) and post-operative (day1, day7, 3month and 6 month) graft blood flow rates were recorded and analyzed. Results were correlated to Matsushima grade determined by DSA performed within 24 h when ultrasonography was conducted to confirm the graft function. RESULTS 100 patients with 131 operated hemispheres were included in this study. The mean flow rates in the STA graft on pre-operative day1, post-operative day 1 and 7, at 3- and 6-month postoperatively were 24.1, 106.7, 112.6, 97.4 and 79.7 ml/min respectively. The mean post-operative flow in the STA graft graded as A/B/C were significantly different (168.0 ± 34.8 ml/min, 91.0 ± 15.5, 42.1 ± 17.2 ml/min, respectively, p = 0.000). 124.5 ml/min and 65.5 ml/min are good cut-off value for predicting post-operative graft Matsushima grade. The analysis also showed excellent agreement between ultrasonography and DSA for assessing bypass function (κ = 0.78). CONCLUSIONS The patency of the STA grafts can be assessed noninvasively by quantitative ultrasonography, which results are comparable to those of conventional DSA. This, therefore, suggest that quantitative ultrasonography may be an alternative method to standard DSA for serial follow up of STA grafts.
Collapse
Affiliation(s)
- Gang Wang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China
| | - Xi'an Zhang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China
| | - Baoping Wang
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China
| | - Yunyu Wen
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China
| | - Siyuan Chen
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China
| | - Junjie Liu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China
| | - Bingbing Ke
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China
| | - Hualan Wu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China
| | - Guozhong Zhang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China
| | - Mingzhou Li
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China
| | - Shichao Zhang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China
| | - Lijing Ji
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China
| | - Yingjia Li
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China.
| | - Wenfeng Feng
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, 510515 Guangzhou, Guangdong, PR China.
| |
Collapse
|
3
|
Muscas G, Bas van Niftrik CH, Fierstra J, Piccirelli M, Sebök M, Burkhardt JK, Valavanis A, Pangalu A, Regli L, Bozinov O. Feasibility and safety of intraoperative BOLD functional MRI cerebrovascular reactivity to evaluate extracranial-to-intracranial bypass efficacy. Neurosurg Focus 2020; 46:E7. [PMID: 30717072 DOI: 10.3171/2018.11.focus18502] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/06/2018] [Indexed: 11/06/2022]
Abstract
Blood oxygenation level-dependent functional MRI cerebrovascular reactivity (BOLD-CVR) is a contemporary technique to assess brain tissue hemodynamic changes after extracranial- intracranial (EC-IC) bypass flow augmentation surgery. The authors conducted a preliminary study to investigate the feasibility and safety of intraoperative 3-T MRI BOLD-CVR after EC-IC bypass flow augmentation surgery. Five consecutive patients selected for EC-IC bypass revascularization underwent an intraoperative BOLD-CVR examination to assess early hemodynamic changes after revascularization and to confirm the safety of this technique. All patients had a normal postoperative course, and none of the patients exhibited complications or radiological alterations related to prolonged anesthesia time. In addition to intraoperative flow measurements of the bypass graft, BOLD-CVR maps added information on the hemodynamic status and changes at the brain tissue level. Intraoperative BOLD-CVR is feasible and safe in patients undergoing EC-IC bypass revascularization. This technique can offer immediate hemodynamic feedback on brain tissue revascularization after bypass flow augmentation surgery.
Collapse
Affiliation(s)
- Giovanni Muscas
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland.,2Department of Neurosurgery, Careggi Hospital, University of Florence, Italy.,3Clinical Neuroscience Center, University Hospital Zurich; and
| | - Christiaan Hendrik Bas van Niftrik
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland.,3Clinical Neuroscience Center, University Hospital Zurich; and
| | - Jorn Fierstra
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland.,3Clinical Neuroscience Center, University Hospital Zurich; and
| | - Marco Piccirelli
- 3Clinical Neuroscience Center, University Hospital Zurich; and.,4Department of Neuroradiology, University Hospital Zurich, University of Zurich, Switzerland; and
| | - Martina Sebök
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland.,3Clinical Neuroscience Center, University Hospital Zurich; and
| | - Jan-Karl Burkhardt
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland.,5Department of Neurosurgery, Baylor College of Medicine Medical Center, Houston, Texas
| | | | - Athina Pangalu
- 3Clinical Neuroscience Center, University Hospital Zurich; and.,4Department of Neuroradiology, University Hospital Zurich, University of Zurich, Switzerland; and
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland.,3Clinical Neuroscience Center, University Hospital Zurich; and
| | - Oliver Bozinov
- 1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland.,3Clinical Neuroscience Center, University Hospital Zurich; and
| |
Collapse
|
4
|
Matsukawa H, Tanikawa R, Kamiyama H, Tsuboi T, Noda K, Ota N, Miyata S, Takeda R, Tokuda S. Graft Occlusion and Graft Size Changes in Complex Internal Carotid Artery Aneurysm Treated by Extracranial to Intracranial Bypass Using High-Flow Grafts with Therapeutic Internal Carotid Artery Occlusion. Neurosurgery 2018; 81:672-679. [PMID: 28368487 DOI: 10.1093/neuros/nyx075] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/06/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although the extracranial-to-intracranial high-flow bypass (EC-IC HFB) continues to be indispensable for complex aneurysms, the risk factors for the graft occlusion and whether the graft size changes after the bypass have not been well established. OBJECTIVE To evaluate the risk factors for the graft occlusion and to confirm whether graft diameters changed over time. METHODS The data of 75 patients who suffered from complex internal carotid artery (ICA) aneurysms and were treated by EC-IC HFB using radial artery graft (RAG) or saphenous vein graft (SVG) with therapeutic ICA occlusion were evaluated. Clinical and radiological characteristics were compared in patients with and without the graft occlusion by the log-rank test. Graft diameters measured preoperatively, postoperatively, at 6 months, and at 1 year were compared by paired t-test. RESULTS During a follow-up period (median 26.2 months), graft occlusions were seen in 4 patients (5.3%), and these were the SVGs. Only SVG was related to graft occlusion (P < .001). There was a significant increase with time in RAG diameters (preoperative, 3.1 ± 0.41 mm; postoperative, 3.6 ± 0.65 mm; 6 months, 4.3 ± 1.0 mm; 1 year, 4.4 ± 1.0 mm), while there were no significant diameter changes in SVGs. CONCLUSION The present study showed that the SVG was related to the graft occlusion and RAGs gradually enlarged. Unless Allen test is negative, RAG may be better to be used as a graft in EC-IC HFB if therapeutic ICA occlusion is needed.
Collapse
Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Toshiyuki Tsuboi
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Shiro Miyata
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rihei Takeda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| |
Collapse
|
5
|
Sekine T, Takagi R, Amano Y, Murai Y, Orita E, Matsumura Y, Kumita SI. 4D flow MRI assessment of extracranial-intracranial bypass: qualitative and quantitative evaluation of the hemodynamics. Neuroradiology 2015; 58:237-44. [DOI: 10.1007/s00234-015-1626-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/25/2015] [Indexed: 02/02/2023]
|
6
|
Tsuchiya K, Imai M, Nitatori T, Kimura T. Postoperative evaluation of superficial temporal artery-middle cerebral artery bypass using an MR angiography technique with combined white-blood and black-blood sequences. J Magn Reson Imaging 2013; 38:671-6. [DOI: 10.1002/jmri.24019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 12/05/2012] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kazuhiro Tsuchiya
- Department of Radiology; Kyorin University Faculty of Medicine; Shinkawa, Mitaka, Tokyo; Japan
| | - Masamichi Imai
- Department of Radiology; Kyorin University Faculty of Medicine; Shinkawa, Mitaka, Tokyo; Japan
| | - Toshiaki Nitatori
- Department of Radiology; Kyorin University Faculty of Medicine; Shinkawa, Mitaka, Tokyo; Japan
| | - Tokunori Kimura
- Toshiba Medical Systems; Shimoishigami, Otawara, Tochigi; Japan
| |
Collapse
|
7
|
Dang Y, Wu B, Sun Y, Mo D, Wang X, Zhang J, Fang J. Quantitative assessment of external carotid artery territory supply with modified vessel-encoded arterial spin-labeling. AJNR Am J Neuroradiol 2012; 33:1380-6. [PMID: 22345497 DOI: 10.3174/ajnr.a2978] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In patients with carotid stenosis or occlusion, cerebral blood could be supplied through collateral pathways to improve regional blood flow and protect against ischemic events. The contribution of collaterals from the ICA can be assessed by depiction of vascular perfusion territories with ASL. However, so far there is no method available to evaluate the collateral perfusion territory from the ECA in MR imaging. In this study, we present a new labeling scheme based on VE-ASL to quantitatively assess the perfusion territory of the ECA. MATERIALS AND METHODS A new labeling approach with a Hadamard encoding scheme was developed to label major arteries, especially the ECA. Twelve healthy subjects with normal cerebrovascular anatomy were examined to demonstrate their perfusion territories. Eight patients with carotid artery stenosis or occlusion were assessed before and after surgery to show changes of their collateral blood supply. RESULTS The proposed method enables assessment of the perfusion territories of the ECA. Good agreement was found between the vascular territories and normal cerebrovascular anatomy in healthy subjects. For the patients with carotid stenosis or occlusion, our noninvasive results provided information on collateral flow comparable with that from DSA. Their collateral flows from the ECA, moreover, could be quantitatively estimated pre- and postoperatively. CONCLUSIONS The modified approach has been validated by the consistency of collateral perfusion territories with cerebrovascular anatomy, and quantitative assessment of collaterals proved useful for assisting in evaluating therapeutic interventions.
Collapse
Affiliation(s)
- Y Dang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | | | | | | | | | | | | |
Collapse
|
8
|
Magnetic Resonance Imaging Flow Quantification of Non-Occlusive Excimer Laser-Assisted EC-IC High-Flow Bypass in the Treatment of Complex Intracranial Aneurysms. Clin Neuroradiol 2011; 22:39-45. [DOI: 10.1007/s00062-011-0116-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022]
|
9
|
Schuette AJ, Dannenbaum MJ, Cawley CM, Barrow DL. Indocyanine green videoangiography for confirmation of bypass graft patency. J Korean Neurosurg Soc 2011; 50:23-9. [PMID: 21892400 DOI: 10.3340/jkns.2011.50.1.23] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 05/01/2011] [Accepted: 07/01/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of the study is to determine the efficacy of indocyanine green (ICG) videoangiography for confirmation of vascular anastomosis patency in both extracranial-intracranial and intracranial-intracranial bypasses. METHODS Intraoperative ICG videoangiography was used as a surgical adjunct for 56 bypasses in 47 patients to assay the patency of intracranial vascular anastomosis. These patients underwent a bypass for cerebral ischemia in 31 instances and as an adjunct to intracranial aneurysm surgery in 25. After completion of the bypass, ICG was administered to assess the patency of the graft. The findings on ICG videoangiography were then compared to intraoperative and/or postoperative imaging. RESULTS ICG provided an excellent visualization of all cerebral arteries and grafts at the time of surgery. Four grafts were determined to be suboptimal and were revised at the time of surgery. Findings on ICG videoangiography correlated with intraoperative and/or postoperative imaging. CONCLUSION ICG videoangiography is rapid, effective, and reliable in determining the intraoperative patency of bypass grafts. It provides intraoperative information allowing revision to reduce the incidence of technical errors that may lead to early graft thrombosis.
Collapse
|
10
|
Yamaguchi K, Kawamata T, Kawashima A, Hori T, Okada Y. Incidence and Predictive Factors of Cerebral Hyperperfusion After Extracranial-Intracranial Bypass for Occlusive Cerebrovascular Diseases. Neurosurgery 2010; 67:1548-54; discussion 1554. [DOI: 10.1227/neu.0b013e3181f8c554] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Although many studies of postoperative cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy have been reported, there are few reports related to extracranial-intracranial (EC-IC) bypass for atherosclerotic occlusive cerebrovascular diseases.
OBJECTIVE:
To examine the incidence of cerebral hyperperfusion and CHS after EC-IC bypass and to investigate predictive factors.
METHODS:
Fifty consecutive patients undergoing EC-IC bypass for atherosclerotic occlusive cerebrovascular diseases were studied. Immediately after bypass surgery, resting regional cerebral blood flow was determined under continuous sedation, and postoperative hyperperfusion was evaluated according to the definitions as follows: > 50% increase in regional cerebral blood flow compared with the contralateral side (method 1) and > 100% increase in corrected regional cerebral blood flow compared with preoperative values (method 2). Logistic regression analysis was conducted to determine the effect of multiple variables on postoperative hyperperfusion.
RESULTS:
Transient symptoms of CHS were observed in 3 patients. Cerebral hyperperfusion was detected in 12 patients (24%) as defined by method 1 and in 9 patients (18%) by method 2. Postoperative hyperperfusion occurred significantly more frequently in patients with the steal phenomenon (regional cerebral vasoreactivity ≤ 0%; P = .001 by method 1 and P = .001 by method 2) and correlated with impaired preoperative regional cerebral vasoreactivity (P < .001). Logistic regression analysis revealed that the steal phenomenon was a significant risk factor for hyperperfusion as defined by both methods 1 (P = .009) and 2 (P = .03).
CONCLUSION:
The incidence of cerebral blood flow-assessed postoperative hyperperfusion after EC-IC bypass for atherosclerotic occlusive cerebrovascular diseases was not rare. Post EC-IC bypass CHS could be reduced by continuous, strict blood pressure control under sedation.
Collapse
Affiliation(s)
- Kohji Yamaguchi
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Akitsugu Kawashima
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomokatsu Hori
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
11
|
Dual energy bone subtraction in computed tomography angiography of extracranial-intracranial bypass: feasibility and limitations. Eur Radiol 2010; 21:750-6. [DOI: 10.1007/s00330-010-1973-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 08/07/2010] [Accepted: 09/06/2010] [Indexed: 10/19/2022]
|
12
|
Magnetic Resonance Angiography With Midsagittal Saturation for the Assessment of Blood Flow From Superficial Temporal Artery-to-Middle Cerebral Artery Bypass. J Comput Assist Tomogr 2010; 34:89-92. [DOI: 10.1097/rct.0b013e3181ac914e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Bacigaluppi S, Dehdashti AR, Agid R, Krings T, Tymianski M, Mikulis DJ. The contribution of imaging in diagnosis, preoperative assessment, and follow-up of moyamoya disease. Neurosurg Focus 2009; 26:E3. [DOI: 10.3171/2009.01.focus08296] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this review was to evaluate the imaging tools used in diagnosis and perioperative assessment of moyamoya disease, with particular attention to the last decade.
Collapse
Affiliation(s)
- Susanna Bacigaluppi
- 1Divisions of Neurosurgery and
- 3Department of Neurosciences and Biomedical Technologies, University of Milan-Bicocca, Milan, Italy
| | | | - Ronit Agid
- 2Neuroradiology, University Health Network, Toronto Western Hospital, University of Toronto, Ontario, Canada; and
| | - Timo Krings
- 2Neuroradiology, University Health Network, Toronto Western Hospital, University of Toronto, Ontario, Canada; and
| | | | - David J. Mikulis
- 2Neuroradiology, University Health Network, Toronto Western Hospital, University of Toronto, Ontario, Canada; and
| |
Collapse
|
14
|
Czabanka M, Vajkoczy P, Schmiedek P, _ _, Horn P. Age-dependent revascularization patterns in the treatment of moyamoya disease in a European patient population. Neurosurg Focus 2009; 26:E9. [DOI: 10.3171/2009.1.focus08298] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Different revascularization procedures are used in the treatment of patients with moyamoya disease (MMD). The aim of this study was to investigate the relative contribution of direct and indirect revascularization procedures to the restoration of collateral blood supply in adult and pediatric patients with MMD.
Methods
The authors performed 39 combined cerebral revascularization procedures (standard extraintracranial bypass [STA-MCA bypass] plus encephalomyosynangiosis [EMS]) in 10 pediatric and 10 adult patients. All patients underwent physical examination and digital subtraction angiography before and 6 months after surgery. The STA-MCA bypass and EMS function were graded as Grade I (poor), II (moderate), or III (good) on the basis of the angiograms.
Results
In pediatric patients, bypass function was Grade I in 12, Grade II in 8, and Grade III in 0 hemispheres; EMS function was Grade I in 0, Grade II in 12, and Grade III in 8 hemispheres. In the adult patients, bypass function was Grade I in 8, Grade II in 8, and Grade III in 3 hemispheres; EMS function was Grade I in 10 hemispheres, Grade II in 5, and Grade III in 1 hemisphere. In the pediatric patients disease was classified as improved in 14 hemispheres on the basis of clinical results and stable in 6. In the adults it was classified as improved in 12 hemispheres stable in 7 hemispheres.
Conclusions
Combined revascularization led to good angiographic and clinical results in both patient populations. Especially in pediatric patients, EMS represents a suitable alternative to bypass surgery.
Collapse
Affiliation(s)
| | - Peter Vajkoczy
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin; and
| | - Peter Schmiedek
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin; and
| | - _ _
- 2Department of Neurosurgery, Klinikum Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Peter Horn
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin; and
| |
Collapse
|
15
|
Assessment of extracranial–intracranial bypass patency with 64-slice multidetector computerized tomography angiography. Neuroradiology 2009; 51:505-15. [DOI: 10.1007/s00234-009-0522-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 03/05/2009] [Indexed: 11/26/2022]
|
16
|
Amin-Hanjani S, Shin JH, Zhao M, Du X, Charbel FT. Evaluation of extracranial-intracranial bypass using quantitative magnetic resonance angiography. J Neurosurg 2007; 106:291-8. [PMID: 17410714 DOI: 10.3171/jns.2007.106.2.291] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT To date, angiography has been the primary modality for assessing graft patency following extracranial-intracranial bypass. The utility of a noninvasive and quantitative method of assessing bypass function postoperatively was evaluated using quantitative magnetic resonance (MR) angiography. METHODS One hundred one cases of bypass surgery performed over a 5.5-year period at a single institution were reviewed. In 62 cases, both angiographic and quantitative MR angiographic data were available. Intraoperative flow measurements were available in 13 cases in which quantitative MR angiography was performed during the early postoperative period (within 48 hours after surgery). There was excellent correlation between quantitative MR angiographic flow and angiographic findings over the mean 10 months of imaging follow up. Occluded bypasses were consistently absent on quantitative MR angiograms (four cases). The flow rates were significantly lower in those bypasses that became stenotic or reduced in diameter as demonstrated by follow-up angiography (nine cases) than in those bypasses that remained fully patent (mean +/- standard error of the mean, 37 +/- 13 ml/minute compared with 105 +/- 7 ml/minute, p = 0.001). Flows were appreciably lower in poorly functioning bypasses for both vein and in situ arterial grafts. All angiographically poor bypasses (nine cases) were identifiable by absolute flows of less than 20 ml/minute or a reduction in flow greater than 30% within 3 months. Good correlation was seen between intraoperative flow measurements and early postoperative quantitative MR angiographic flow measurements (13 cases, Pearson correlation coefficient = 0.70, p = 0.02). CONCLUSIONS Bypass grafts can be assessed in a noninvasive fashion by using quantitative MR angiography. This imaging modality provides not only information regarding patency as shown by conventional angiography, but also a quantitative assessment of bypass function. In this study, a low or rapidly decreasing flow was indicative of a shrunken or stenotic graft. Quantitative MR angiography may provide an alternative to standard angiography for serial follow up of bypass grafts.
Collapse
Affiliation(s)
- Sepideh Amin-Hanjani
- Neuropsychiatric Institute, Department of Neurosurgery, University of Illinois at Chicago, Illinois 60612-5970, USA.
| | | | | | | | | |
Collapse
|
17
|
Abstract
Treatment of acute aneurysmal subarachnoid hemorrhages consists of occluding the aneurysm to prevent rebleed, attempting to prevent vasospasm, and maintaining blood flow to the brain through vessels in vasospasm. Endovascular treatment has been shown to be as safe as, or safer, than surgical clipping for patients with SAH. Engineering solutions to our clinical problems continue to improve endovascular outcomes. This article reviews the current state of endovascular therapy.
Collapse
Affiliation(s)
- Stephen Chang
- Department of Radiology and Neurosurgery, Johns Hopkins Medical Institution, Baltimore, MD 21287, USA
| | | | | |
Collapse
|