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Tao T, Zhu W, Yu J, Li X, Wei W, Hu M, Luo M, Wan G, Li P, Chen J, Zhang J. Intraoperative evaluation of local cerebral hemodynamic change by laser speckle contrast imaging for predicting postoperative cerebral hyperperfusion during STA-MCA bypass in adult patients with moyamoya disease. J Cereb Blood Flow Metab 2024; 44:1163-1173. [PMID: 38233750 PMCID: PMC11179619 DOI: 10.1177/0271678x241226483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/19/2024]
Abstract
Cerebral hyperperfusion (CHP) occurred frequently after direct superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery for moyamoya disease (MMD). We analyzed cortical microvascular density (CMD) and the change of cerebral blood flow (LΔCBF) using intraoperative laser speckle contrast imaging (LSCI) on 130 hemispheres of 95 consecutive adult patients with MMD. The demographic characteristics, cortical hemodynamic sources, bypass methods, intraoperative blood flow data, and relative CBF changes on single-photon emission computed tomography (SPECT) examination (SΔrCBF) were compared between the groups with and without CHP. The median values for CMD, LΔCBF, and SΔrCBF were significantly higher in the CHP group than in the non-CHP group (CMD 0.240 vs 0.206, P = 0.004; LΔCBF 2.285 vs 1.870, P < 0.001; SΔCBF 1.535 vs 1.260, P < 0.001). Multivariate analysis revealed that hemodynamic sources of recipient parasylvian cortical arteries from MCA (M-PSCAs), end-to-side (E-S) bypass method, CMD ≥ 0.217, and LΔCBF ≥ 1.985 were the risk factors for CHP. Intraoperative LSCI was useful for evaluating hemodynamics and predicting CHP in patients with MMD.
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Affiliation(s)
- Tianshu Tao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Wenting Zhu
- Britton Chance Center and MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Yu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Xiang Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Wei Wei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Miao Hu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Mingrui Luo
- Department of Neurosurgery, WuHan Third Hospital, Wuhan, China
| | - Guiping Wan
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Pengcheng Li
- Britton Chance Center and MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Jianjian Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
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Guo Z, Yan Z, Qu F, Cheng D, Wang C, Feng Y. The value of indocyanine green-FLOW800 in microvasculature for predicting cerebral hyperperfusion syndrome in moyamoya disease patients. Sci Rep 2023; 13:18352. [PMID: 37884669 PMCID: PMC10603131 DOI: 10.1038/s41598-023-45676-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023] Open
Abstract
Among the notable complications of direct hemodynamic reconstruction for moyamoya disease (MMD) is cerebral hyperperfusion syndrome (CHS). In this study, we evaluated hemodynamic changes in small regional microvasculature (SRMV) around the anastomosis site by using indocyanine green (ICG)-FLOW800 video angiography and verified that it better predicted the onset of CHS. Intraoperative ICG-FLOW800 analysis was performed on 31 patients (36 cerebral hemispheres) with MMD who underwent superficial temporal artery-middle cerebral artery (MCA) bypass grafting at our institution. The regions of interest were established in the SRMV and thicker MCA around the anastomosis. Calculations were made for half-peak to time (TTP1/2), cerebral blood volume (CBV), and cerebral blood flow (CBF). According to the presence or absence of CHS after surgery, CHS and non-CHS groups of patients were separated. The results showed that ΔCBV and ΔCBF were substantially greater in SRMV than in MCA (p < 0.001). Compared with the non-CHS group, ΔCBF and ΔCBV of SRMV and MCA were considerably greater in the CHS group (p < 0.001). ΔCBF and ΔCBV on the ROC curve for both SRMV and MCA had high sensitivity and specificity (SRMV: ΔCBF, AUC = 0.8586; ΔCBV, AUC = 0.8158. MCA: ΔCBF, AUC = 0.7993; ΔCBV, AUC = 0.8684). ICG-FLOW800 video angiography verified the differential hemodynamic changes in the peri-anastomotic MCA and SRMV before and after bypass surgery in patients with MMD.
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Affiliation(s)
- Zhongxiang Guo
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Jiangsu Road No. 16, Qingdao, 266003, Shandong Province, China
| | - Zhaohui Yan
- Department of Neurosurgery, Haiyang People's Hospital, Haiyang Road No. 37, Haiyang, 265199, Shandong Province, China
| | - Fan Qu
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Jiangsu Road No. 16, Qingdao, 266003, Shandong Province, China
| | - Dekui Cheng
- Department of Neurosurgery, Liaocheng People's Hospital, Dongchang West Road No. 67, Liaocheng, 25200, Shandong Province, China
| | - Chao Wang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Jiangsu Road No. 16, Qingdao, 266003, Shandong Province, China
| | - Yugong Feng
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Jiangsu Road No. 16, Qingdao, 266003, Shandong Province, China.
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Cao L, Yuan X, Dong Y, Wang Z, Guo M, Li D, Zhang M, Yan D, Yang B, Li H. Multimodal evaluation of the bloodstream alteration before and after combined revascularization for Moyamoya disease. Front Neurol 2023; 14:1249914. [PMID: 37780715 PMCID: PMC10540193 DOI: 10.3389/fneur.2023.1249914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023] Open
Abstract
Objective This study aimed to explore the hemodynamic changes before and after anastomosis in patients with Moyamoya disease (MMD) using multiple models. Methods We prospectively enrolled 42 MMD patients who underwent combined revascularization. Intraoperative FLOW800 was performed before and after anastomosis, and parameters was collected, including maximum intensity, delay time, rise time, slope, blood flow index, and microvascular transit time (MVTT). Additionally, preoperative and postoperative hemodynamic parameters were measured using color Doppler ultrasonography (CDUS), including peak systolic velocity, end-diastolic velocity, resistance index (RI), pulsatility index (PI), and flow volume. Subsequently, the correlation between FLOW800 and CDUS parameters was explored. Results A total of 42 participants took part with an average age of 46.5 years, consisting of 19 men and 23 women. The analysis of FLOW800 indicated that both the delay time and rise time experienced a substantial decrease in both the recipient artery and vein. Additionally, the MVTT was found to be significantly reduced after the surgery (5.7 ± 2.2 s vs. 4.9 ± 1.6, p = 0.021). However, no statistically significant differences were observed among the other parameters. Similarly, all postoperative parameters in CDUS hemodynamics exhibited significant alterations in comparison to the preoperative values. The correlation analysis between FLOW800 and CDUS parameters indicated a significant association between MVTT and RI and PI, no significant relationships were found among the other parameters in the two groups. Conclusion The hemodynamic outcomes of the donor and recipient arteries demonstrated significant changes following bypass surgery. The parameter of time appears to be more precise and sensitive in assessing hemodynamics using FLOW800. Multiple evaluations of hemodynamics could offer substantial evidence for perioperative management.
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Affiliation(s)
- Lei Cao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoli Yuan
- Department of Hematology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yang Dong
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zeming Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengguo Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongpeng Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Manxia Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongming Yan
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Yang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongwei Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Tsuge I, Munisso MC, Kosaka T, Takaya A, Sowa Y, Liu C, Yamamoto G, Saito S, Morimoto N. Preoperative visualization of midline-crossing subcutaneous arteries in transverse abdominal flaps using photoacoustic tomography. J Plast Reconstr Aesthet Surg 2023; 84:165-175. [PMID: 37331038 DOI: 10.1016/j.bjps.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 03/01/2023] [Accepted: 05/14/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Photoacoustic tomography is a noninvasive vascular imaging modality that uses near-infrared pulsed laser light and ultrasound to visualize vessels. We previously demonstrated the utility of photoacoustic tomography for anterolateral thigh flap surgery involving body-attachable vascular mapping sheets. However, it was not possible to obtain clear separate images of arteries and veins. In this study, we tried to visualize subcutaneous arteries that cross the midline of the abdomen, since these arteries are known to be important for obtaining large perfusion areas in transverse abdominal flaps. METHODS Four patients scheduled to undergo breast reconstruction with abdominal flaps were examined. Photoacoustic tomography was performed preoperatively. The tentative arteries and veins were traced according to the S-factor, an approximate hemoglobin oxygen saturation parameter calculated using 2 laser excitation wavelengths (756 and 797 nm). Intraoperatively, arterial-phase indocyanine green (ICG) angiography was performed after abdominal flap elevation. Images of vessels speculated to be arteries by preoperative photoacoustic tomography were merged with those of intraoperative ICG angiography and analyzed in an 8 × 4-cm2 area below the umbilical region. RESULTS The S-factor was used to visualize the midline-crossing subcutaneous arteries in all 4 patients. A matching analysis compared preoperative tentative arteries according to photoacoustic tomography with ICG angiography results in the 8 × 4-cm2 area below the umbilical region and indicated a 71.3-82.1% match (average: 76.9% match). CONCLUSIONS This study demonstrates that the S-factor, a noninvasive, label-free imaging modality, can be used to successfully visualize subcutaneous arteries. This information can aid in selecting perforators for abdominal flap surgery.
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Affiliation(s)
- Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Maria Chiara Munisso
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoko Kosaka
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ayako Takaya
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshihiro Sowa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Chang Liu
- Department of Medical Informatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Goshiro Yamamoto
- Department of Medical Informatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Saito
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Lin J, Wu Y, Deng X, Zhou S, Liu Y, Zhang J, Zeng Y, Li X, Gao X, Xu B, Zhou C. Application of intraoperative infrared thermography in bypass surgery for adult moyamoya syndrome: A preliminary study. Front Neurol 2023; 14:1174072. [PMID: 37064202 PMCID: PMC10098335 DOI: 10.3389/fneur.2023.1174072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/14/2023] [Indexed: 04/01/2023] Open
Abstract
Background and objectivesCerebral revascularization surgery is the mainstay of treatment for moyamoya syndrome (MMS) today, and intraoperative determination of the patency of the revascularized vessel is a critical factor in the success of the procedure. Currently, major imaging modalities include intraoperative indocyanine green (ICG) videoangiography (ICG-VA), digital subtraction angiography (DSA), and vascular ultrasound Doppler. Infrared thermography is a modern imaging modality with non-contact devices for the acquisition and analysis of thermal data. We aimed to investigate the feasibility and advantages of infrared thermography in determining anastomotic patency during MMS surgery.MethodsIndocyanine green videoangiography and infrared thermography were performed simultaneously in 21 patients with MMS who underwent bypass surgery. The detection result of vessel patency was compared, and the feasibility and advantages of infrared thermography were assessed.ResultsThe patency of the anastomosis was accurately determined in 21 patients using either ICG angiography or infrared thermography. In 20 patients, the results of infrared thermography showed that the vascular anastomosis was unobstructed, and there was an agreement with the subsequent results of ICG-VA. In one patient, we suspected inadequate patency after testing the anastomosis with infrared thermography, and the results of ICG-VA evaluation of the anastomosis confirmed that there was indeed an anastomotic obstruction.ConclusionCompared with ICG-VA, infrared thermography might offer an alternative non-invasive, contrast-free option in assessing anastomosis patency compared with ICG-VA, and it is likely to become more widely used in the clinic in the near future.
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Affiliation(s)
- Jinghui Lin
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Yiwen Wu
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Xinpeng Deng
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Shengjun Zhou
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Yuchun Liu
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Junjun Zhang
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Yiyong Zeng
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Xianru Li
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Xiang Gao
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
- Xiang Gao,
| | - Bin Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Bin Xu,
| | - Chenhui Zhou
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
- *Correspondence: Chenhui Zhou,
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Zhang D, Li X, Jia N, Chen W, Hu Y. Bibliometric and visual analysis of cerebral revascularization from 1999 to 2022. Front Neurosci 2023; 16:1088448. [PMID: 36699511 PMCID: PMC9868924 DOI: 10.3389/fnins.2022.1088448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background Cerebral revascularization is a neurosurgical procedure used to restore the cerebral collateral circulation channel. This study examines the countries, institutions, authors, journals, keywords, and references related to the disease in the field of cerebral revascularization from 1999 to 2022 from a bibliometrics perspective, evaluates the changes of knowledge structure clustering and identifies the new hot spots and new research directions in this field. Methods The Web of Science Core Collection (WOSCC) database and the PICOS retrieval method were used to conduct a comprehensive search for articles and reviews pertaining to cerebral revascularization. The final filtered data were bibliometrically and visually drawn using Microsoft office 365, CiteSpace (v.6.1.R2), and VOSviewer (v.1.6.18). Results From 1999 to 2022, a total of 854 articles pertaining to cerebral revascularization, which originated from 46 nations, 482 institutions, and 686 researchers, were extracted from the WOSCC database, and the number of publications in this field of study was rising. The United States held the highest proportion in the ranking analysis of countries, institutions, authors, and journals. By analyzing co-citations, the scientific organization of this field and the development status of frontier fields were realized. Cerebral revascularization, moyamoya disease, extracranial intracranial bypass, and occlusion are the current research focal points in the field of cerebral revascularization. Hyperperfusion and vascular disorder may also become a new study focus in this discipline in the near future. Conclusion Using the method of bibliometrics, this study analyzed and reviewed the articles in the field of cerebral revascularization, which enabled scholars to better comprehend the dynamic process in this field and provided a foundation for future in-depth research.
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Affiliation(s)
- Ding Zhang
- Guangxi University of Chinese Medicine, Nanning, China
| | - Xiaoqian Li
- Weinan Vocational and Technical College Nursing College, Weinan, China
| | - Ni Jia
- Department of Encephalopathy, The First Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xi’an, China
| | - Wei Chen
- Department of Encephalopathy, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Yueqiang Hu
- Department of Encephalopathy, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China,*Correspondence: Yueqiang Hu,
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Skandalakis GP, Kalyvas A, Lani E, Komaitis S, Manolakou D, Chatzopoulou D, Pantazis N, Zenonos GA, Hadjipanayis CG, Stranjalis G, Koutsarnakis C. Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery. Brain Circ 2022; 8:207-214. [PMID: 37181839 PMCID: PMC10167845 DOI: 10.4103/bc.bc_43_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cerebral hyperperfusion syndrome (CHS) following bypass surgery is a major cause of neurological morbidity and mortality. However, data regarding its prevention have not been assorted until date. OBJECTIVE The objective of this study was to review the literature and evaluate whether any conclusion can be drawn regarding the effectiveness of any measure on preventing bypass-related CHS. METHODS We systematically reviewed PubMed and Cochrane Library from September 2008 to September 2018 to collect data regarding the effectiveness of pharmacologic interventions on the refers to pretreatment (PRE) of bypass-related CHS. We categorized interventions regarding their class of drugs and their combinations and calculated overall pooled estimates of proportions of CHS development through random-effects meta-analysis of proportions. RESULTS Our search yielded 649 studies, of which 23 fulfilled inclusion criteria. Meta-analysis included 23 studies/2,041 cases. In Group A (blood pressure [BP] control), 202 out of 1,174 pretreated cases developed CHS (23.3% pooled estimate; 95% confidence interval [CI]: 9.9-39.4), Group B (BP control + free radical scavenger [FRS]) 10/263 (0.3%; 95% CI: 0.0-14.1), Group C (BP control + antiplatelet) 22/204 (10.3%; 95% CI: 5.1-16.7), and Group D (BP control + postoperative sedation) 29/400 (6.8%; 95% CI: 4.4-9.6)]. CONCLUSIONS BP control alone has not been proven effective in preventing CHS. However, BP control along with either a FRS or an antiplatelet agent or postoperative sedation seems to reduce the incidence of CHS.
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Affiliation(s)
- Georgios P. Skandalakis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
- Department of Neurosurgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Aristotelis Kalyvas
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Evgenia Lani
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
- Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Spyridon Komaitis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
- Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Danai Manolakou
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva University Hospitals, Geneva, Switzerland
| | - Despoina Chatzopoulou
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios A. Zenonos
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Constantinos G. Hadjipanayis
- Department of Neurosurgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Department of Neurosurgery, Icahn School of Medicine Mount Sinai Beth Israel, Mount Sinai Health System, New York, NY, USA
| | - George Stranjalis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
- Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Christos Koutsarnakis
- Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
- Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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Kanamori F, Araki Y, Yokoyama K, Uda K, Mamiya T, Nishihori M, Izumi T, Okamoto S, Natsume A. <Editors' Choice> Indocyanine green emission timing of the recipient artery in revascularization surgery for moyamoya disease. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 83:523-534. [PMID: 34552287 PMCID: PMC8438003 DOI: 10.18999/nagjms.83.3.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Abstract
In superficial temporal artery to middle cerebral artery anastomosis with indirect revascularization for patients with moyamoya disease, the optimal method for selecting the most appropriate cortical artery for the recipient in anastomosis has not been established. We investigated the relationship between the fluorescence emission timing of the recipient artery in the preanastomosis indocyanine green videoangiography and operative outcomes. This retrospective study included 51 surgical revascularization procedures for 39 moyamoya disease patients. The enrolled surgical procedures were classified into three groups based on the fluorescence emission timing of the recipient artery in preanastomosis indocyanine green videoangiography: the EARLIEST, the INTERMEDIATE, and the LATEST. Clinical characteristics and operative outcomes were also collected. The occurrence of white thrombus at the anastomosis site and symptomatic hyperperfusion showed significant differences between the groups classified by the fluorescence emission timing of the recipient artery in preanastomosis indocyanine green videoangiography (white thrombus, p = 0.001; symptomatic hyperperfusion, p = 0.026). The development of white thrombi was significantly higher in the LATEST group, and all symptomatic hyperperfusion was observed in the EARLIEST group. These results indicated that the LATEST group had a significantly higher risk for developing white thrombus, and the EARLIEST group was prone to occur symptomatic hyperperfusion. Selecting the recipient artery based on evaluating the fluorescence emission timing in preanastomosis indocyanine green videoangiography may be useful in reducing perioperative complications.
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Affiliation(s)
- Fumiaki Kanamori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japann
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japann
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japann
| | - Kenji Uda
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japann
| | - Takashi Mamiya
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japann
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japann
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japann
| | - Sho Okamoto
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japann
| | - Atsushi Natsume
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japann
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Imaging methods for surgical revascularization in patients with moyamoya disease: an updated review. Neurosurg Rev 2021; 45:343-356. [PMID: 34417671 PMCID: PMC8827314 DOI: 10.1007/s10143-021-01596-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 02/08/2023]
Abstract
Neuroimaging is crucial in moyamoya disease (MMD) for neurosurgeons, during pre-surgical planning and intraoperative navigation not only to maximize the success rate of surgery, but also to minimize postsurgical neurological deficits in patients. This is a review of recent literatures which updates the clinical use of imaging methods in the morphological and hemodynamic assessment of surgical revascularization in patients with MMD. We aimed to assist surgeons in assessing the status of moyamoya vessels, selecting bypass arteries, and monitoring postoperative cerebral perfusion through the latest imaging technology.
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10
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Yang D, Zhang X, Tan C, Han Z, Su Y, Duan R, Shi G, Shao J, Cao P, He S, Wang R. Intraoperative transit-time ultrasonography combined with FLOW800 predicts the occurrence of cerebral hyperperfusion syndrome after direct revascularization of Moyamoya disease: a preliminary study. Acta Neurochir (Wien) 2021; 163:563-571. [PMID: 33006072 DOI: 10.1007/s00701-020-04599-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cerebral hyperperfusion syndrome (CHS) is a common complication after direct bypass surgery in patients with Moyamoya disease (MMD). Since preventive measures may be inadequate, we assessed whether the blood flow difference between the superficial temporal artery (STA) and recipient vessels (△BF) and the direct perfusion range (DPR) are related to CHS. METHODS We measured blood flow in the STA and recipient blood vessels before bypass surgery by transit-time probe to calculate △BF. Perfusion changes around the anastomosis before and after bypass were analyzed with FLOW800 to obtain DPR. Multiple factors, such as △BF, DPR, and postoperative CHS, were analyzed using binary logistic regression. RESULTS Forty-one patients with MMD who underwent direct bypass surgery were included in the study. Postoperative CHS symptoms occurred in 13/41 patients. △BF and DPR significantly differed between the CHS and non-CHS groups. The optimal receiver operating characteristic (ROC) curve cut-off value was 31.4 ml/min for ΔBF, and the area under the ROC curve (AUC) was 0.695 (sensitivity 0.846, specificity 0.500). The optimal cut-off value was 3.5 cm for DPR, and the AUC was 0.702 (sensitivity 0.615, specificity 0.750). CONCLUSION Postoperative CHS is caused by multiple factors. △BF is a risk factor for CHS while DPR is a protective factor against CHS.
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Rennert RC, Strickland BA, Ravina K, Bakhsheshian J, Fredrickson V, Carey J, Russin JJ. Intraoperative Assessment of Cortical Perfusion After Intracranial-To-Intracranial and Extracranial-To-Intracranial Bypass for Complex Cerebral Aneurysms Using Flow 800. Oper Neurosurg (Hagerstown) 2020; 16:583-592. [PMID: 29897545 DOI: 10.1093/ons/opy154] [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: 02/02/2018] [Accepted: 05/22/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Revascularization strategies for complex cerebral aneurysms are largely based on subjective interpretation of flow demands, or indirect measures of perfusion in at-risk territories. Indocyanine Green -based flow analyses ((ICG-BFA); Flow 800, Carl Zeiss, Oberkochen, Germany) provide a real-time, semiquantitative measure of intraoperative cortical perfusion during cerebral bypass surgery for complex aneurysms. OBJECTIVE To determine the utility of intraoperative ICG-BFA for assessing cortical perfusion in at-risk territories during cerebral bypass for complex aneurysms requiring vessel sacrifice. METHODS Retrospective analysis of consecutive patients from a prospective, single-institution open cerebrovascular database. RESULTS Intraoperative ICG-BFA confirmed adequate cortical perfusion in 2 patients with fusiform posterior circulation aneurysms, treated with a posterior inferior cerebellar artery (PICA)-PICA and occipital artery (OA)-to-third segment of the posterior cerebral artery (P3) bypass with proximal vessel sacrifice, respectively. ICG-BFA was used in a third patient that underwent clip reconstruction/ intracranial-to-intracranial bypass for a large middle cerebral artery (MCA) bifurcation aneurysm requiring sacrifice of the temporal M2 branch. In this case, a frontal M3 to temporal M3 side-to-side anastomosis was created to arborize the MCA tree and allow filling of both M2 territories through a single M2 branch. After aneurysm reconstruction, ICG-BFA identified an inadvertent occlusion of the frontal M2 that left the entire MCA distribution reliant on collateral flow but did not cause a neuromonitoring change. Repeat ICG-BFA after clip re-arrangement demonstrated aneurysm occlusion and equal flow in both frontal and temporal MCA cortical distributions from the arborization. CONCLUSION ICG-BFA is a useful adjunct for intraoperative cortical flow assessment during cerebral revascularization for complex aneurysms requiring vessel sacrifice.
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Affiliation(s)
- Robert C Rennert
- Department of Neurological Surgery, University of California San Diego, San Diego, California
| | - Ben A Strickland
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kristine Ravina
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joshua Bakhsheshian
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Vance Fredrickson
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joseph Carey
- Department of Plastic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jonathan J Russin
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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12
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Evaluation of Hemodynamic Change by Indocyanine Green-FLOW 800 Videoangiography Mapping: Prediction of Hyperperfusion Syndrome in Patients with Moyamoya Disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:8561609. [PMID: 32850003 PMCID: PMC7441439 DOI: 10.1155/2020/8561609] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022]
Abstract
Objective Hyperperfusion syndrome (HPS) after bypass surgery for moyamoya disease (MMD) mainly results from redistribution of blood flow, which leads to poor outcomes, while effective methods to predict HPS are still lacking. Indocyanine green (ICG) videoangiography can assess regional cerebral blood flow changes semiquantitatively with the application of FLOW 800 software. The purpose of this study was to investigate whether the intraoperative evaluation of local hemodynamic changes around anastomotic sites using FLOW 800 videoangiography mapping can predict the incidence of HPS and clinical outcomes. Methods Of the patients who were diagnosed with MMD in our hospital between August 2018 and December 2019, who underwent superficial temporal artery-middle cerebral artery bypass surgeries, we investigated 65 hemispheres (in 62 patients) in which intraoperative ICG analysis was performed using FLOW 800 (Zeiss Meditec, Oberkochen, Germany) to evaluate the local cerebral hemodynamics before and after anastomosis. Regions of interest were set at more than 2 points on the brain surface according to the location and situation of recipient arteries in the surgical area. Peak cerebral blood volume (CBV), regional cerebral blood flow (CBF), and time to peak (TTP) were calculated from the selected points. As the data were available intraoperatively, anastomoses were performed in a suitable area. According to the occurrence of HPS, patients were divided into the asymptomatic and symptomatic groups, from which hemodynamic parameters were compared. Furthermore, ROC analysis was performed to determine the diagnostic accuracy of change rates in CBV, CBF, and TTP (i.e., ΔCBV, ΔCBF, and ΔTTP) for predicting HPS. Results Data from the 62 patients were analyzed, and all patients were closely assessed during hospitalization after the procedures. The values of ΔCBV and ΔCBF were significantly higher in the symptomatic group (p < 0.01), while ΔTTP is slightly lower in the symptomatic group with no statistical differences (p = 0.72). Hemodynamic parameters including ΔCBV and ΔCBF, calculated by FLOW 800, had high sensitivity and specificity according to the ROC curve (ΔCBV: AUC = 0.743, 95% CI, 0.605-0.881, p = 0.002; ΔCBF: AUC = 0.852, 95% CI, 0.750-0.954, p < 0.01), which could be used as predictors for HPS. Conclusions Intraoperative ICG-FLOW 800 videoangiography mapping is a safe method which can reflect hemodynamic characteristics in the surgical area for MMD, the findings of which correlate with the occurrence of HPS. Parameters including ΔCBV and ΔCBF are proven to be efficient in the prediction of HPS.
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Asymmetric cerebral edema presenting with severe neurologic impairment and seizures after cardiac and thoracic interventions. J Stroke Cerebrovasc Dis 2020; 29:105003. [PMID: 32689610 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION A syndrome of focal neurologic deficits with characteristic imaging features, acute encephalopathy, and seizures after cardiac and thoracic interventions has been previously briefly reported in the literature. In a retrospective observational study, we aim to identify the prevalence and characteristics of this syndrome, in addition to discussing the possible underlying pathophysiology. METHODS In a retrospective study, we reviewed records of consecutive adult patients (≥18 years old) who underwent cardiac and thoracic procedures at a single institution between September 2014 to September 2019 and found to have evidence of focal cerebral edema following their procedure. We included and reported clinical course of patients who developed post-operative neurologic dysfunction and underwent magnetic resonance imaging (MRI) showing (1) asymmetric cerebral edema with (2) cortical diffusion restriction and (3) T2 cortical or subcortical hyperintensity and (4) no proximal vascular occlusion. RESULTS Three out of 107 patients (2.8%) met our inclusion criteria. These represented one male and two females with age at presentation of 63, 81 and 69, respectively. All patients developed severe neurologic impairment on the same day following their procedure (sternotomy with valve or bypass surgery in 2 patients; esophageal dilatation procedure in 1 patient). All patients underwent MRI of the brain and vessel imaging qualifying our inclusion criteria. Two patients improved neurologically prior to discharge, and one patient expired after family elected to withdraw care. CONCLUSION We present a series of cases with a rare syndrome after cardiac and thoracic interventions. Although the exact mechanism of this syndrome remains unclear, we believe it to be related to relative cerebral hyperperfusion and cerebral dysautoregulation following anesthesia and thoracic manipulation. Future studies should focus on understanding the true prevalence and pathophysiology of this syndrome.
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Rennert RC, Strickland BA, Russin JJ. Commentary: Whole-Field Indocyanine Green Intensity Analysis to Intraoperatively Predict Cerebral Hyperperfusion Syndrome Following Superficial Temporal Artery-Middle Cerebral Artery Bypass: A Retrospective Case-Control Study in 7-Year Experience With 112 Cases. Oper Neurosurg (Hagerstown) 2020; 18:E193-E194. [PMID: 31642498 DOI: 10.1093/ons/opz322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/02/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert C Rennert
- Department of Neurological Surgery, University of California San Diego, San Diego, California
| | - Ben A Strickland
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jonathan J Russin
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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15
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Sato Y, Sugiyama T, Mizutani T. Whole-Field Indocyanine Green Intensity Analysis to Intraoperatively Predict Cerebral Hyperperfusion Syndrome Following Superficial Temporal Artery-Middle Cerebral Artery Bypass: A Retrospective Case-Control Study in 7-Year Experience With 112 Cases. Oper Neurosurg (Hagerstown) 2020; 18:652-659. [PMID: 31538195 DOI: 10.1093/ons/opz282] [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: 04/05/2019] [Accepted: 07/10/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intraoperative prediction of postoperative cerebral hyperperfusion syndrome (CHS) after cerebrovascular bypass surgery is challenging. OBJECTIVE To conduct a retrospective case-control study with indocyanine green (ICG) intensity analysis of the superficial temporal artery-middle cerebral artery (STA-MCA) bypass and investigate whether its washout pattern might be a marker for intraoperative prediction of CHS. METHODS Between 2012 and 2018, 6 of 112 patients (5.4%) that underwent STA-MCA bypass exhibited CHS. We selected 5 patients with CHS (3 with atherosclerotic cerebrovascular disease [ASCVD] and 2 with moyamoya) and 15 patients without CHS (60% ASCVD and 40% moyamoya) as a matched control group. During prebypass and postbypass, washout times (WTs) for the first 10%, 25%, 50%, and 75% of maximum ICG intensity measured in the whole-camera field were compared between groups. The changes in WT (ΔWT) from prebypass to postbypass for each ICG intensity level were compared between groups. The cutoff ΔWTs, sensitivities, and specificities were also calculated. RESULTS Postbypass WTs were significantly longer in the CHS group than the control group at all ICG intensities (P < .05). ΔWT was significantly greater in the CHS group than the control group for the first 10%, 25%, and 50% ICG intensities (P < .001). A cutoff ΔWT of ≥2.66 s for the first 50% ICG intensity showed a sensitivity of 100% and specificity of 100%. CONCLUSION We found that a ΔWT ≥2.66 s for the first 50% ICG intensity could be an intraoperative predictive factor for CHS.
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Affiliation(s)
- Yosuke Sato
- Department of Neurosurgery, School of Medicine, Showa University, Tokyo, Japan
| | - Tatsuya Sugiyama
- Department of Neurosurgery, School of Medicine, Showa University, Tokyo, Japan
| | - Tohru Mizutani
- Department of Neurosurgery, School of Medicine, Showa University, Tokyo, Japan
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Chen Y, Ma L, Lu J, Chen X, Ye X, Zhang D, Zhang Y, Wang R, Zhao Y. Postoperative hemorrhage during the acute phase after direct or combined revascularization for moyamoya disease: risk factors, prognosis, and literature review. J Neurosurg 2019; 133:1450-1459. [PMID: 31628285 DOI: 10.3171/2019.7.jns19885] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/26/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Postoperative hemorrhage during the acute phase is rarely observed after revascularization surgery for moyamoya disease (MMD) but can have severe complications. Its risk factors and outcomes are still unclear. The aim of this study was to investigate the predictors of postoperative hemorrhage during the acute phase in MMD and examine the outcomes of the hemorrhage. METHODS The authors reviewed the preoperative clinical characteristics and radiographic features of 465 consecutive MMD cases (518 procedures) that had undergone direct or combined bypass surgery at their institution between 2009 and 2015. Patients with postoperative intracerebral hemorrhage (ICH) or ICH plus intraventricular hemorrhage (IVH) during the acute phase were screened, and then the incidence, location, and risk factors of hemorrhage in these patients were analyzed. Short-term and long-term outcomes (modified Rankin Scale scores) for these patients were also collected. Outcomes were compared between patients with and those without postoperative ICH using propensity score analysis to reduce the between-group differences in baseline characteristics. RESULTS Postoperative hemorrhage occurred in 11 (2.1%; ICH = 9, IVH = 2) of 518 procedures (mean patient age 39.82 ± 8.8 years). Hemorrhage occurred in the first 24 hours after the operation in 8 cases (72.7%). In the ICH group, most of the hemorrhage sites (77.8%) were located beneath the anastomosed area, and the mean hematoma volume was 16.98 ± 22.45 ml (range 3-57 ml). One case from the ICH group required hematoma evacuation. Among the adult patients (463 procedures [89.4%]), preoperative hypertension (p = 0.008), CT perfusion (CTP) stage > III (p = 0.013), and posterior circulation involvement (p = 0.022) were significantly associated with postoperative ICH. No significant differences between the postoperative ICH group and the no-hemorrhage group were detected in terms of postoperative neurofunctional status at discharge (p = 0.569) or at the last follow-up (p = 1.000). Neither was there a significant difference in future stroke risk (p = 0.538) between these two groups. CONCLUSIONS Preoperative hypertension, CTP stage > III, and posterior circulation involvement are independent risk factors for postoperative ICH after direct or combined revascularization for MMD. After appropriate perioperative management, postoperative ICH has no significant correlations with the postoperative short-term and long-term neurofunctional status.
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Affiliation(s)
- Yu Chen
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Li Ma
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- 3China National Clinical Research Center for Neurological Diseases
- 4Stroke Center, Beijing Institute for Brain Disorders
- 5Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; and
| | - Junlin Lu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Xiaolin Chen
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- 3China National Clinical Research Center for Neurological Diseases
- 4Stroke Center, Beijing Institute for Brain Disorders
- 5Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; and
| | - Xun Ye
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- 2Department of Neurosurgery, Peking University International Hospital, Peking University
- 3China National Clinical Research Center for Neurological Diseases
- 4Stroke Center, Beijing Institute for Brain Disorders
- 5Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; and
| | - Dong Zhang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- 3China National Clinical Research Center for Neurological Diseases
- 4Stroke Center, Beijing Institute for Brain Disorders
| | - Yan Zhang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- 3China National Clinical Research Center for Neurological Diseases
- 4Stroke Center, Beijing Institute for Brain Disorders
| | - Rong Wang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- 2Department of Neurosurgery, Peking University International Hospital, Peking University
- 3China National Clinical Research Center for Neurological Diseases
- 4Stroke Center, Beijing Institute for Brain Disorders
| | - Yuanli Zhao
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
- 2Department of Neurosurgery, Peking University International Hospital, Peking University
- 3China National Clinical Research Center for Neurological Diseases
- 4Stroke Center, Beijing Institute for Brain Disorders
- 5Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; and
- 6Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, People's Republic of China
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Rennert RC, Strickland BA, Ravina K, Bakhsheshian J, Russin JJ. Assessment of Hemodynamic Changes and Hyperperfusion Risk After Extracranial-to-Intracranial Bypass Surgery Using Intraoperative Indocyanine Green-Based Flow Analysis. World Neurosurg 2018; 114:352-360. [PMID: 29626683 DOI: 10.1016/j.wneu.2018.03.189] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intraoperative blood flow assessments during cerebral bypass would ideally assess vessel patency, downstream perfusion, and risk of postoperative hyperperfusion syndrome (HPS). Previous studies using indocyanine green-based flow analyses (ICG-BFA) have identified multiple parameters that can intraoperatively track bypass-related changes in cerebral perfusion and potentially predict postoperative risk of HPS. Herein, we determine the most robust parameter and anatomic location for intraoperative ICG-BFA assessment of bypass-related perfusion changes and prediction of postoperative risk of HPS. METHODS Retrospective analysis of an institutional review board-approved prospective database identified patients undergoing superficial temporal artery-to-middle cerebral artery bypass. Demographic and clinical information, as well as manually calculated and automated pre- and postbypass intraoperative ICG-BFA data from cortical, arterial, and venous regions of interest were recorded and analyzed. RESULTS Seven patients underwent superficial temporal artery-to-middle cerebral artery bypass (4 Moyamoya, 3 carotid occlusions). Average age was 48.2 ± 13.9 years (3 female, 4 male). Although all parameters measured showed trends toward improvement postbypass, only changes in arterial and venous automated ICG-BFA slope (also known as blood flow index [maximum intensity/rise time]) reached significance. None of the patients experienced symptomatic HPS, despite 5 of 7 (71.4%) having an increased HPS risk based on previously published ICG-BFA data. CONCLUSIONS ICG-BFA has utility for the intraoperative assessment of bypass-related changes in cerebral perfusion, with automated blood flow index being the most robustly affected parameter. Although previously published ICG-BFA indices did not predict the development of symptomatic postoperative HPS, larger-scale studies correlating observed ICG-BFA changes with risk of HPS are warranted.
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Affiliation(s)
- Robert C Rennert
- Department of Neurological Surgery, University of California San Diego, San Diego, California, USA
| | - Ben A Strickland
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kristine Ravina
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joshua Bakhsheshian
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jonathan J Russin
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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