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Chen Z, Zhang L, Qu J, Wu Y, Mao G, Zhu X, Zhu J. Clinical analysis of combined revascularization in treating ischemic Moyamoya disease in adults. Neurochirurgie 2018; 64:49-52. [PMID: 29455906 DOI: 10.1016/j.neuchi.2017.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 05/23/2017] [Accepted: 08/19/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the clinical efficacy of superficial temporal artery-middle cerebral artery anastomosis (STA-MCA)+encephalo-duro-myo-synangiosis (EDMS) in treating ischemic Moyamoya disease (IMD) in adults. METHODS A total of 30 adult patients with IMD were selected to be included in the study; they underwent STA-MCA+EDMS and were followed up for 3 months to 2 years. The digital subtraction angiography findings, modified Rankin scale (mRs) score, and complications of all the patients were compared. RESULTS Thirty patients successfully completed the surgery. Three patients had postoperative complications (two patients with cerebral infarction on the surgical side and one patient with poor scalp healing). The postoperative morbidity rate was 10%. Angiography conducted at 3 to 6 months postoperatively showed 28 cases of anastomotic patency; the anastomotic patency rate was 93.3%. The mRs scores of the patients' neurological function 3 months after surgery were lower than those before surgery. CONCLUSION STA-MCA+EDMS is effective in treating Moyamoya disease.
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Affiliation(s)
- Z Chen
- Department of neurosurgery, the second affiliated hospital of Nanchang university, Nanchang 330006, People's Republic of China
| | - L Zhang
- Department of neurosurgery, the second affiliated hospital of Nanchang university, Nanchang 330006, People's Republic of China
| | - J Qu
- Department of neurosurgery, the second affiliated hospital of Nanchang university, Nanchang 330006, People's Republic of China
| | - Y Wu
- Department of neurosurgery, the second affiliated hospital of Nanchang university, Nanchang 330006, People's Republic of China
| | - G Mao
- Department of neurosurgery, the second affiliated hospital of Nanchang university, Nanchang 330006, People's Republic of China
| | - X Zhu
- Department of neurosurgery, the second affiliated hospital of Nanchang university, Nanchang 330006, People's Republic of China
| | - J Zhu
- Department of neurosurgery, the second affiliated hospital of Nanchang university, Nanchang 330006, People's Republic of China.
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Temporary Steno-occlusive Change in the Donor Artery During Mouth Opening (Big Bite Ischemic Phenomenon) After Superficial Temporal Artery to Middle Cerebral Artery Bypass in Adult Patients with Moyamoya Disease and Atherosclerosis. ACTA NEUROCHIRURGICA. SUPPLEMENT 2017. [PMID: 27637638 DOI: 10.1007/978-3-319-29887-0_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND Superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is one of the most common surgical procedures performed for direct extracranial (EC) to intracranial (IC) bypasses. We describe a temporary steno-occlusive change in the STA that was caused by mouth opening after the STA-MCA bypass (so-called big bite ischemic phenomenon) in an adult patient with moyamoya disease. The aim of this study was to assess the incidence of this phenomenon in patients with atherosclerosis. METHODS Adult patients with ischemic cerebrovascular disease who underwent STA-MCA anastomosis were included in this study. Ultrasound examinations were postoperatively performed on 62 sides to determine whether mouth opening affected the blood flow of the donor STA and resulted in any ischemic symptoms within 1 min. Computed tomography angiography was performed during both mouth opening and closing when blood flow changes were recognized in the donor STA. RESULTS During wide mouth opening, steno-occlusion of the donor STA occurred in 8 of the 62 affected sides (12.9 %), which included 3 of the 47 sides (6.4 %) in patients with atherosclerosis and 5 of the 15 sides (33.3 %) in patients with moyamoya disease. CONCLUSION Steno-occlusion of the donor STA occurred during wide mouth opening in 12.9 % of the sides of adult patients who had undergone STA-MCA anastomosis. This phenomenon was more common in patients with moyamoya disease than in patients with atherosclerosis.
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Katsuta T, Abe H, Miki K, Inoue T. Reversible occlusion of donor vessel caused by mouth opening after superficial temporal artery-middle cerebral artery anastomosis in adult moyamoya patients. J Neurosurg 2015; 123:670-5. [PMID: 25909570 DOI: 10.3171/2014.10.jns141805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors experienced an intriguing phenomenon in 2 adult patients with moyamoya disease. Mouth opening caused reversible occlusion of the donor superficial temporal artery (STA), and the patients exhibited transient cerebral ischemic symptoms. The aim of this study was to assess the incidence of such occlusion and the mechanism of this phenomenon. METHODS Twelve consecutive adult patients with moyamoya disease (15 affected sides) who underwent STA-middle cerebral artery anastomosis were included in this study. Ultrasound examination was performed more than 3 months postoperatively to determine whether mouth opening affected blood flow of the donor STA and led to any ischemic symptoms within 1 minute. Computed tomography angiography was performed during both mouth opening and mouth closing, when blood flow changes of the donor STA were recognized. RESULTS Under wide mouth opening, steno-occlusion of the donor STA occurred in 5 of 15 sides (33.3%). On 1 side (6.7%), complete occlusion induced ischemic symptoms. Steno-occlusion occurred by at least 2 mechanisms: either the stretched temporalis muscle pushed the donor STA against the edge of the bone window, or the redundant donor STA kinked when the muscle was stretched. CONCLUSIONS Even with temporary occlusion of the donor STA, ischemic symptoms seem to rarely occur. However, to avoid the "big bite ischemic phenomenon," the authors recommend securing a sufficient distance between the donor STA and the edge of the bone window and avoiding a redundant course of the donor STA within the muscle layer.
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Affiliation(s)
- Toshiro Katsuta
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Koichi Miki
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Chui J, Manninen P, Sacho RH, Venkatraghavan L. Anesthetic Management of Patients Undergoing Intracranial Bypass Procedures. Anesth Analg 2015; 120:193-203. [DOI: 10.1213/ane.0000000000000470] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Melgar MA, Mariwalla N, Madhusudan H, Weinand M. Carotid endarterectomy without shunt: the role of cerebral metabolic protection. Neurol Res 2013; 27:850-6. [PMID: 16354546 DOI: 10.1179/016164105x3997] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The optimal method to protect the brain from hemodynamic ischemia during carotid endarterectomy (CEA) remains controversial. This study reports our experience with induced arterial hypertension and selective etomidate cerebral protection in a cohort of patients who underwent CEA without shunting and continuous electroencephalography (EEG) monitoring. METHODS We reviewed retrospectively 102 consecutive CEAs performed in 102 patients with routine EEG monitoring and general anesthesia between March 1998 and October 2002. There were 65 (66%) symptomatic and 37 (34%) asymptomatic individuals. A protocol of induced arterial hypertension against EEG ischemic changes during carotid artery cross clamping was followed. Only patients with EEG changes refractory to induced hypertension went into etomidate-induced burst suppression. RESULTS EEG changes were classified as mild, moderate and severe. Twenty patients (19.6%) developed asymmetric EEG changes, of which the great majority were mild and moderate (75%, p< 0.05). Seven patients with moderate (n=3) and severe (n=4) EEG changes needed etomidate cerebral protection. There were no mortalities and only one stroke (0.98%) is reported in the series. The morbidity rate was 6.8% and included transient cranial nerve palsies (n=5) and wound hematoma (n=1). CONCLUSIONS Carotid endarterectomy can be safely performed with EEG monitoring and selective induced arterial hypertension and etomidate cerebral protection. Our results suggest that this method may be a good alternative for shunting and its inherent risks.
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Affiliation(s)
- Miguel A Melgar
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
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Watanabe Y, Tanaka H, Dan I, Sakurai K, Kimoto K, Takashima R, Hirata K. Monitoring cortical hemodynamic changes after sumatriptan injection during migraine attack by near-infrared spectroscopy. Neurosci Res 2011; 69:60-6. [DOI: 10.1016/j.neures.2010.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 09/14/2010] [Accepted: 09/15/2010] [Indexed: 10/19/2022]
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Awano T, Sakatani K, Yokose N, Kondo Y, Igarashi T, Hoshino T, Nakamura S, Fujiwara N, Murata Y, Katayama Y, Shikayama T, Miwa M. Intraoperative EC-IC bypass blood flow assessment with indocyanine green angiography in moyamoya and non-moyamoya ischemic stroke. World Neurosurg 2010; 73:668-74. [PMID: 20934154 DOI: 10.1016/j.wneu.2010.03.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 03/15/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis has been used in moyamoya disease (MD) and non-moyamoya ischemic stroke (non-MD). It is important to monitor hemodynamic changes caused by bypass surgery for postoperative management. We evaluated the bypass blood flow during STA-MCA anastomosis by using indocyanine green (ICG) fluorescence angiography. METHODS We evaluated the bypass blood flow in 13 MD and 21 non-MD patients during STA-MCA anastomosis by means of ICG angiography with injection of ICG into the anastomosed STA. The ICG perfusion area was calculated when the ICG fluorescence intensity reached maximum. We measured cortical oxygen saturation before anastomosis by means of visual light spectroscopy. RESULTS ICG angiography demonstrated bypass blood flow from the anastomosed STA to the cortical vessels in all patients. The ICG perfusion area in MD (20.7 ± 6.6 cm(2)) was significantly larger than that in non-MD (8.4 ± 9.1 cm(2), P < 0.05). The cortical oxygen saturation (58.9% ± 8.3%) in MD was significantly lower than that in non-MD (73.4% ± 9.5%, P < 0.05). CONCLUSIONS ICG angiography with injection of ICG into the bypass artery allowed quantitative assessment of bypass blood flow. The bypass supplies blood flow to a greater extent in MD than in non-MD during surgery. This might be caused by a larger pressure gradient between the anastomosed STA and recipient vessels in MD. These observations indicate that MD requires careful control of systemic blood pressure after surgery to avoid cerebral hyperperfusion syndrome. ICG angiography is considered useful for facilitating safe and accurate bypass surgery and providing information for postoperative management.
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Affiliation(s)
- Takayuki Awano
- Department of Neurological Surgery, Division of Neurosurgery, Nihon University School of Medicine, Tokyo, Japan
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Mapping of Optical Pathlength of Human Adult Head at Multi-Wavelengths in Near Infrared Spectroscopy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2010; 662:205-12. [DOI: 10.1007/978-1-4419-1241-1_29] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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EC-IC Bypass Function in Moyamoya Disease and Non-Moyamoya Ischemic Stroke Evaluated by Intraoperative Indocyanine Green Fluorescence Angiography. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2009. [DOI: 10.1007/978-1-4419-1241-1_75] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Nakamizo A, Inoue T, Kikkawa Y, Uda K, Hirata Y, Okamura K, Yasaka M, Okada Y. Postoperative evaluation of changes in extracranial-intracranial bypass graft using superficial temporal artery duplex ultrasonography. AJNR Am J Neuroradiol 2009; 30:900-5. [PMID: 19193755 DOI: 10.3174/ajnr.a1468] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Extracranial-intracranial (ECIC) bypass grafts have been assessed postoperatively by various neuroradiologic techniques. The aim of this prospective study was to evaluate postoperative changes in ECIC bypass graft by using superficial temporal artery duplex ultrasonography (STDU). Furthermore, this study assessed the ability of STDU to predict cerebrovascular reserve capacity (CVR). MATERIALS AND METHODS Forty-five consecutive patients who underwent ECIC bypass procedure for atherosclerotic internal carotid artery occlusion were enrolled in this prospective study. All patients underwent single-photon emission CT and STDU preoperatively, 14 days after, 3 months after, 1 year after, and 2 years after ECIC bypass. RESULTS The diameter and flow velocities of the ipsilateral superficial temporal artery (STA), and regional cerebral blood flow (rCBF) showed increase during the first 2 weeks and then remained stable, whereas CVR showed a constant improvement up to 2 years after surgery. The STA diameter and mean STA flow velocity correlated significantly with CVR at 1 year after surgery (r2 = 0.1232 and r2 = 0.08716, respectively; P < .05). A cutoff value of 1.8 mm STA diameter was determined as the most reliable value to predict CVR greater than 10% at 1 year after surgery. The positive predictive value was calculated as 96.6%, the negative predictive value as 43.8%, the sensitivity as 75.7%, the specificity as 87.5%, and the likelihood ratio as 6.056. CONCLUSIONS ECIC bypass grafts can be assessed postoperatively in a noninvasive fashion with STDU. This technique provides information regarding patency as well as quantitative assessment of bypass function. Moreover, STDU is useful to predict CVR improvement.
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Affiliation(s)
- A Nakamizo
- Department of Neurosurgery, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
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Hayden MG, Lee M, Guzman R, Steinberg GK. The evolution of cerebral revascularization surgery. Neurosurg Focus 2009; 26:E17. [DOI: 10.3171/2009.3.focus0931] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Among the relatively few surgeons to be awarded the Nobel Prize was Alexis Carrel, a French surgeon and pioneer in revascularization surgery at the turn of the 20th century. The authors trace the humble beginnings of cerebral revascularization surgery through to the major developments that helped shape the modern practice of cerebral bypass surgery. They discuss the cornerstone studies in the development of this technique, including the Extracranial/Intracranial Bypass Study initiated in 1977. Recent innovations, including modern techniques to monitor cerebral blood flow, microanastomosis techniques, and ongoing trials that play an important role in the evolution of this field are also evaluated.
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Garrett MC, Komotar RJ, Starke RM, Merkow MB, Otten ML, Sciacca RR, Connolly ES. The efficacy of direct extracranial-intracranial bypass in the treatment of symptomatic hemodynamic failure secondary to athero-occlusive disease: a systematic review. Clin Neurol Neurosurg 2009; 111:319-26. [PMID: 19201526 DOI: 10.1016/j.clineuro.2008.12.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2008] [Revised: 12/16/2008] [Accepted: 12/19/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The 1985 International Extracranial-Intracranial (EC-IC) Bypass Trial failed to show a benefit following surgery in patients with varying degrees of angiographic ICA stenosis. More recent studies using modern technology to identify appropriate candidates, however, have generated promising findings. As a result, controversy exists regarding the role of this technique in the treatment of symptomatic athero-occlusive disease. To this end, we performed a systematic review and quantitative analysis of the literature to determine if a subset of patients with symptomatic hemodynamic failure secondary to athero-occlusive disease may benefit from direct EC-IC bypass. METHODS We performed a MEDLINE (1985-2007) database search using the following keywords, singly and in combination: EC-IC bypass, hemodynamic failure and misery perfusion. Additional studies were identified manually by scrutinizing references from identified manuscripts, major neurosurgical journals and texts, and personal files. Our literature search divided studies into three categories: natural history of patients with stage I hemodynamic failure (16 studies, 2320 patients), natural history of patients with stage II hemodynamic failure (3 studies 163 patients), and outcomes of patients with hemodynamic failure treated by EC-IC bypass (23 studies 506 patients). RESULTS Patients with severe stage I and stage II hemodynamic failure are at higher risk of cerebral infarction than those with mild disease (p=.014, OR 1.17-4.08 and p=0.10, OR 0.89-3.63, respectively). Additionally, patients with severe hemodynamic failure respond better to surgery than those with mild disease (p=0.03, OR 0.16-0.92). CONCLUSIONS Patients with severe hemodynamic failure secondary to athero-occlusive disease appear to benefit from direct EC-IC bypass surgery. As a result, the conclusions of the 1985 International EC-IC Bypass Trial may not be applicable to this subset of patients. A randomized clinical trial involving this patient population is warranted.
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Affiliation(s)
- Matthew C Garrett
- Department of Neurosurgery, Columbia University, New York, NY 10032, United States
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Garrett MC, Komotar RJ, Merkow MB, Starke RM, Otten ML, Connolly ES. The extracranial-intracranial bypass trial: implications for future investigations. Neurosurg Focus 2008; 24:E4. [PMID: 18275299 DOI: 10.3171/foc/2008/24/2/e4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The 1985 International Extracranial-Intracranial (EC-IC) Bypass Trial failed to show a surgical benefit of EC-IC bypass in patients with varying degrees of angiographic stenosis. This study was limited by the technology available at the time it was conducted. In the 20 years since, there has been considerable progress in imaging techniques that now enable the identification of a subset of stroke patients with hemodynamic ischemia. In the present study, the authors review the relevant literature and propose a reevaluation of the benefits of the EC-IC bypass procedure using these new imaging techniques. The authors reviewed the admission criteria for the EC-IC Bypass Trial in the light of more recently discovered neurovascular physiology and showed that the imaging criteria used in that trial are not physiologically adequate. A MED-LINE (1985-2007) database search for EC-IC case studies was conducted, and additional studies were identified manually by scrutinizing references from identified manuscripts, major neurosurgical journals and texts, and personal files.
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Affiliation(s)
- Matthew C Garrett
- Department of Neurosurgery, Columbia University, New York, New York 10032, USA
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Tsuzuki D, Jurcak V, Singh AK, Okamoto M, Watanabe E, Dan I. Virtual spatial registration of stand-alone fNIRS data to MNI space. Neuroimage 2007; 34:1506-18. [PMID: 17207638 DOI: 10.1016/j.neuroimage.2006.10.043] [Citation(s) in RCA: 430] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 10/24/2006] [Accepted: 10/26/2006] [Indexed: 11/17/2022] Open
Abstract
The registration of functional brain data to common stereotaxic brain space facilitates data sharing and integration across different subjects, studies, and even imaging modalities. Thus, we previously described a method for the probabilistic registration of functional near-infrared spectroscopy (fNIRS) data onto Montreal Neurological Institute (MNI) coordinate space that can be used even when magnetic resonance images of the subjects are not available. This method, however, requires the careful measurement of scalp landmarks and fNIRS optode positions using a 3D-digitizer. Here we present a novel registration method, based on simulations in place of physical measurements for optode positioning. First, we constructed a holder deformation algorithm and examined its validity by comparing virtual and actual deformation of holders on spherical phantoms and real head surfaces. The discrepancies were negligible. Next, we registered virtual holders on synthetic heads and brains that represent size and shape variations among the population. The registered positions were normalized to MNI space. By repeating this process across synthetic heads and brains, we statistically estimated the most probable MNI coordinate values, and clarified errors, which were in the order of several millimeters across the scalp, associated with this estimation. In essence, the current method allowed the spatial registration of completely stand-alone fNIRS data onto MNI space without the use of supplementary measurements. This method will not only provide a practical solution to the spatial registration issues in fNIRS studies, but will also enhance cross-modal communications within the neuroimaging community.
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Affiliation(s)
- Daisuke Tsuzuki
- Sensory and Cognitive Food Science Laboratory, National Food Research Institute, 2-1-12 Kannondai, Tsukuba 305-8642, Japan
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Murata Y, Sakatani K, Hoshino T, Fujiwara N, Kano T, Nakamura S, Katayama Y. Effects of Cerebral Ischemia on Evoked Cerebral Blood Oxygenation Responses and BOLD Contrast Functional MRI in Stroke Patients. Stroke 2006; 37:2514-20. [PMID: 16946162 DOI: 10.1161/01.str.0000239698.50656.3b] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
To evaluate the mechanisms of failure of blood oxygenation level–dependent (BOLD) imaging in stroke, we compared the evoked cerebral blood oxygenation (CBO) responses and activation volumes (AVs) of BOLD functional MRI (fMRI) in chronic stroke patients with moderate and severe cerebral ischemia.
Methods—
We measured the evoked CBO responses in the primary sensorimotor cortex (PSMC) by means of near-infrared spectroscopy during contralateral motor tasks. We compared the AV of BOLD-functional MRI in the PSMC on the nonlesion and lesion sides. Single-photon emission computed tomography was used to classify ischemic status as moderate (slight reduction of regional cerebral blood flow and cerebrovascular reserve capacity [CVRC]) or severe (marked reduction of regional cerebral blood flow and CVRC; ie, misery perfusion).
Results—
In age-matched controls, deoxyhemoglobin concentration decreased with concomitant increases in oxyhemoglobin and total hemoglobin concentrations during activation. The PSMC on the nonlesion side exhibited a normal CBO response pattern. On the lesion side, moderate cerebral ischemia did not affect the CBO response pattern, but severe cerebral ischemia caused an increase of deoxyhemoglobin during the task, associated with increases of oxyhemoglobin and total hemoglobin. Moderate cerebral ischemia induced only a slight reduction of the AV on the lesion side; however, severe cerebral ischemia markedly reduced the AV on the lesion side. The BOLD signal did not change in some areas of the PSMC on the lesion side in severe cerebral ischemia, whereas it tended to decrease in other areas during the tasks.
Conclusions—
Misery perfusion caused a marked reduction of the AV on BOLD imaging, associated with an increase of deoxyhemoglobin concentration during activation. BOLD-fMRI investigations of stroke patients should be performed while giving consideration to baseline circulatory status. Functional near-infrared spectroscopy could be an alternative means to assess the CVRC.
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Affiliation(s)
- Yoshihiro Murata
- Department of Neurosurgery, Nihon University School of Medicine, 30-1, Oyaguchi-Kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
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Hoshino T, Katayama Y, Sakatani K, Kano T, Murata Y. Intraoperative monitoring of cerebral blood oxygenation and hemodynamics during extracranial-intracranial bypass surgery by a newly developed visible light spectroscopy system. ACTA ACUST UNITED AC 2006; 65:569-76; discussion 576. [PMID: 16720176 DOI: 10.1016/j.surneu.2005.09.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Revised: 08/08/2005] [Accepted: 09/06/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cerebrovascular reconstruction procedures run the risk of changing the balance between oxygen supply and consumption during surgery. We assessed the value of visual light spectroscopy for detecting changes in cerebral blood oxygenation (CBO) during superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. METHODS We developed a VLS monitoring system which permits continuous monitoring of CBO changes during surgery. Using the VLS, we evaluated the CBO changes in the MCA territory on the lesion side in 18 patients who underwent STA-MCA anastomosis. RESULTS Temporary occlusion of the MCA (M4 portion) did not change the CBO in 17 patients. However, in the patient with dissecting aneurysm, it caused decreases of oxyhemoglobin and cortical oxygen saturation (CoSo(2)) associated with an increase of deoxyhemoglobin, although these CBO changes were normalized by STA blood flow. In 5 patients, STA blood flow increased the oxyhemoglobin and CoSo(2) and decreased the deoxyhemoglobin, indicating that cortical blood flow (CoBF) was increased. The CoSo(2) before anastomosis was significantly low in the patients who showed an increase of CoSo(2) by STA blood flow (63.0% +/- 2.5%) as compared with those who did not (72.0 +/- 6.1%, P = .024). CONCLUSION Temporary occlusion of a cortical artery during bypass surgery did not affect the CBO in patients who had chronic cerebral ischemia, but caused acute ischemia in the patient who did not. STA blood flow increased the CoBF during surgery more frequently in patients who showed a low perfusion pressure. The VLS monitoring system is considered useful for evaluating bypass function and facilitates safe and accurate bypass surgery.
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Affiliation(s)
- Tatsuya Hoshino
- Department of Neurological Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo 173-8610, Japan
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Bozzao A, Fasoli F, Finocchi V, Santoro G, Romano A, Fantozzi LM. Long term evaluation of brain perfusion with magnetic resonance in high flow extracranial-intracranial saphenous graft bypass. Eur Radiol 2006; 17:33-8. [PMID: 16733681 DOI: 10.1007/s00330-006-0293-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 03/29/2006] [Accepted: 04/10/2006] [Indexed: 10/24/2022]
Abstract
Assessment was made of the cerebral vascular haemodynamic parameters in patients with a high-flow extra-intracranial (EC-IC) bypass performed for therapeutic occlusion of the internal carotid artery (ICA). Sixteen patients with ICA occlusion and EC-IC bypass (time interval from surgery 1-6 years) underwent MRI. Perfusion-weighted magnetic resonance imaging (PW-MRI) sequences were performed without the use of an arterial input function. The relative cerebral blood volume (rCBV), mean transit time (MTT) and relative cerebral blood flow (rCBF) were evaluated in all patients at the level of the basal ganglia, centrum semiovale and cortex in both hemispheres. Statistically significant differences (P<0.005) were observed in the haemodynamic parameters, indicating increased rCBV in the basal ganglia and decreased rCBF and rCBV in the cortex of the hemisphere supplied by the graft with respect to the contralateral. Patients with occlusion of the ICA and high flow EC-IC bypass do have altered vascular haemodynamic status between the hemispheres. In particular, rCBF is impaired in the surgical hemisphere at the level of the cortex. These patients should be followed-up to rule out chronic ischemia.
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Affiliation(s)
- Alessandro Bozzao
- Department of Neuroradiology, II Faculty of Medicine, University of Rome La Sapienza, Rome, Italy.
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Hoshino T, Sakatani K, Kano T, Murata Y, Katayama Y. Cerebral blood oxygenation changes induced by bypass blood flow in moyamoya disease and non-moyamoya cerebral ischaemic disease. Acta Neurochir (Wien) 2006; 148:551-7; discussion 557. [PMID: 16467961 DOI: 10.1007/s00701-006-0733-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Accepted: 12/06/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis has been used to prevent stroke in patients with moyamoya disease (MD) and non-moyamoya ischaemic disease (non-MD). However, little is yet known regarding the difference between these groups of patients in the extent to which the bypass contributes to maintaining adequate cerebral blood oxygenation (CBO), or the temporal changes after surgery. In the present study, we evaluated the CBO changes induced by bypass blood flow in patients with MD and non-MD during the peri-operative periods employing optical spectroscopy. METHODS We investigated 13 patients who underwent STA-MCA anastomosis, including 5 MD and 8 non-MD patients. We evaluated the effects of STA blood flow on the CBO in the MCA territory on the anastomosis side, employing visual light spectroscopy during surgery and near infrared spectroscopy (NIRS) at one week after surgery. FINDINGS In 4 MD patients and one non-MD patient, the STA blood flow increased the oxyhaemoglobin and cortical oxygen saturation (CoSO2), indicating that the bypass supplied blood flow to the ischaemic brain; the CBO changes were observed more frequently in MD than in non-MD patients (p<0.02). The pre-anastomosis CoSO2 (65.4+/-5.4%) in MD was significantly lower than that (72.8+/-7.6%) in non-MD (p<0.05). Postoperative NIRS demonstrated that the bypass began to supply blood flow to the brain in 5 non-MD patients whose bypass did not supply blood flow during surgery. CONCLUSIONS Although MD has vessels of small diameter as compared to non-MD, the bypass begins to supply blood flow to the ischaemic brain earlier in MD than in non-MD after anastomosis. The fact that the CoSO2 in MD was lower than that in non-MD suggested that the perfusion pressure in MD was lower than that in non-MD, and this might account for the difference in the bypass blood supply after anastomosis between MD and non-MD. Our data suggest that, even if the bypass does not supply blood to the brain during surgery in non-MD, the bypass blood flow gradually increases after surgery.
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Affiliation(s)
- T Hoshino
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
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Herzig R, Hluštík P, Urbánek K, Vaverka M, Buřval S, Macháč J, Vlachová I, Křupka B, Bártková A, Šaňák D, Mareš J, Kaňovský P. CAN WE IDENTIFY PATIENTS WITH CAROTID OCCLUSION WHO WOULD BENEFIT FROM EC/IC BYPASS? REVIEW. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2004. [DOI: 10.5507/bp.2004.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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