Complementary Relation Between Direct and Indirect Bypass in Progress of Collateral Circulation in Moyamoya Disease

Komura, Shoichi; Mikami, Takeshi; Sugino, Toshiya; Suzuki, Yuto; Komatsu, Katsuya; Wanibuchi, Masahiko; Mikuni, Nobuhiro

doi:10.1016/j.wneu.2017.04.122

Cited by 13 publications

(12 citation statements)

References 33 publications

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“…Further reported complications are hernia formation, bowel injury, ileus, bowel obstruction, peritonitis, and intestinal volvulus [40]. Of note, Navarro et al emphasized that the use of laparoscopic technique permits to reduce the incision length, the bowel manipulation, and the rate of laparotomy-related complications [8].…”

Section: Omental Transplantationmentioning

confidence: 99%

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Limits and pitfalls of indirect revascularization in moyamoya disease and syndrome

et al. 2020

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Moyamoya vasculopathy is a rare chronic cerebrovascular disorder characterized by the stenosis of the terminal branches of the internal carotid arteries and the proximal tracts of anterior and middle cerebral arteries. Although surgical revascularization does not significantly change the underlying pathogenic mechanisms, it plays a pivotal role in the management of affected individuals, allowing to decrease the risk of ischemic and hemorrhagic complications. Surgical approaches may be direct (extracranial-intracranial bypass), indirect, or a combination of the two. Several indirect techniques classifiable according to the tissue (muscle, periosteum, galea, dura mater, and extracranial tissues) or vessel (artery) used as a source of blood supply are currently available. In this study, we reviewed the pertinent literature and analyzed the advantages, disadvantages, and pitfalls of the most relevant indirect revascularization techniques. We discussed the technical aspects and the therapeutical implications of each procedure, providing a current state-of-the-art overview on the limits and pitfalls of indirect revascularization in the treatment of moyamoya vasculopathy.

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Section: Omental Transplantationmentioning

confidence: 99%

“…Surgical techniques can be categorized as direct, indirect, or a combination of the two [7]. Extracranial-intracranial bypass (e.g., STA-MCA anastomosis) is generally the standard direct surgical procedure [8]. Indirect revascularization techniques employ a variety of tissues as a source of blood supply to induce angiogenesis [6,9].…”

Section: Introductionmentioning

confidence: 99%

Limits and pitfalls of indirect revascularization in moyamoya disease and syndrome

et al. 2020

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“…The process of revascularization is rapid, occurring within a few minutes to a few days [19][20][21]. Zhang et al [4] have confirmed the clinical significance of hemodynamic parameters change in bypass surgery to predict perioperative complications, which has a high spatial resolution.…”

Section: Postoperative Psd Changes In Different Frequency Bandsmentioning

confidence: 99%

Application of intraoperative electrocorticography in bypass surgery for adult moyamoya disease: a preliminary study

Zhang¹,

Su²,

Yu³

et al. 2022

Front. Biosci. (Landmark Ed)

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Objective: Postoperative complications of surgical revascularization in moyamoya disease (MMD) are difficult to predict because of poor knowledge of the underlying pathophysiological process. Since the aim of surgery is to improve brain dynamics by increasing regional blood flow, we hypothesize that postoperative complications are closely related to aberrant electrophysiological changes. Thus, we evaluated the clinical significance of intraoperative electrocorticography (iECoG) in bypass surgery for adult MMD. Methods: Ninetyone adult patients operated on by the same neurosurgeon in our institute were involved (26 in the iECoG group, 65 in the traditional group). Two 1 × 6 subdural electrode grids were placed parallel to the middle frontal gyrus and superior temporal gyrus to record ECoG data continuously during the procedure in the iECoG group. Selected from several M4 candidate arteries, the recipient artery was determined to be closer to the cortex with lower power spectral density (PSD) in the beta band. The PSD parameter we used was the (delta+theta)/(alpha+beta) (DTAB) ratio (DTABR). Next, the pre-and post-bypass PSD values were evaluated, and correlations between post-/pre-bypass PSD parameter ratios and neurological/neuropsychological performance (in terms of changes in National Institutes of Health Stroke Scale [NIHSS] and Mini-Mental State Examination [MMSE] scores) were analyzed. Results: Postoperative complications (transient neurological events) in the iECoG group were significantly lower than those in the traditional group (p = 0.046). In the iECoG group, the post-/pre-bypass DTABR ratio in the bypass area was significantly correlated with postoperative NIHSS (p = 0.002, r 2 = 0.338) and MMSE changes (p = 0.007, r 2 = 0.266). In the nonbypass area, neither postoperative NIHSS nor MMSE changes showed a significant correlation with the post-/pre-bypass DTABR ratio (p > 0.05). Additionally, patients with postoperative complications exhibited significantly higher DTABR (1.67 ± 0.33 vs. 0.95 ± 0.08, p = 0.003) and PSD of the theta band (1.54 ± 0.21 vs. 1.13 ± 0.08, p = 0.036). Conclusions: This study is the first to explain and guide surgical revascularization from the perspective of electrophysiology. Intraoperative ECoG is not only sensitive in reflecting and predicting postoperative neurological and cognitive performance but also usable as a reference for recipient artery selection.

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“…Second, we did not consider the influences of preoperative hemodynamic status and the effect of STA-MCA anastomosis on collateral developments. Because a complementary relationship has been reported between direct and indirect revascularization, 1,13,20 quantitative assessment of these factors will provide more definitive conclusions. Third, we did not evaluate the contribution of other small arteries, such as the transverse facial, zygomatico-orbital, zygomaticotemporal, zygomatico-facial, and posterior auricular arteries, that supply blood to the temporal region.…”

Section: Limitationsmentioning

confidence: 99%

Sagittal splitting of the temporalis muscle for encephalo-myo-synangiosis to prevent ischemic complications due to a swollen temporalis muscle without inhibiting collateral developments in patients with moyamoya disease

Machida

Higuchi

Nakano

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Encephalo-myo-synangiosis (EMS) is an effective revascularization procedure for the treatment of moyamoya disease (MMD). However, the temporalis muscle used for EMS sometimes swells and causes ischemic complications by compressing the underlying brain. This study aimed to elucidate the effect of sagittal splitting (SS) of the muscle for prevention of ischemic complications and its impact on the postoperative development of collateral vessels. METHODS In this historical case-control study, we analyzed 60 hemispheres in adult patients with MMD who underwent EMS using the temporalis muscle from December 1998 to November 2017. The muscle was divided anteroposteriorly by coronal splitting, and the anterior, posterior, or both parts of the muscle were used for EMS in 17, 4, and 39 hemispheres, respectively. In cases performed after 2006, the muscle was halved by SS, and the medial half was used for EMS to reduce the muscle volume (n = 47). The degree of postoperative muscle swelling was evaluated by measuring the maximum thickness of the muscle on CT scans obtained 3 to 7 days after surgery. The collateral developments of the anterior deep temporal artery (aDTA), posterior deep temporal artery (pDTA), and middle temporal artery (MTA) were assessed using digital subtraction angiography and MR angiography performed 6 months or more after surgery. RESULTS SS significantly reduced the temporalis muscle thickness from 12.1 ± 5.0 mm to 7.1 ± 3.0 mm (p < 0.01). Neurological deterioration due to the swollen temporalis muscle developed in 4 of the 13 hemispheres without SS (cerebral infarction in 1, reversible neurological deficit in 2, and convulsion in 1) but in none with SS. There were no significant differences in the postoperative collateral developments of the aDTA, pDTA, and MTA between hemispheres with and without SS. The MTA more frequently developed in hemispheres with EMS in which the posterior part of the muscle was used (30/37) than those in which this part was not used (4/16) (p < 0.01). CONCLUSIONS SS of the temporalis muscle might prevent neurological deterioration caused by the swollen temporalis muscle by reducing its volume without inhibiting the development of the collateral vessels.

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Complementary Relation Between Direct and Indirect Bypass in Progress of Collateral Circulation in Moyamoya Disease

Cited by 13 publications

References 33 publications

Limits and pitfalls of indirect revascularization in moyamoya disease and syndrome

Limits and pitfalls of indirect revascularization in moyamoya disease and syndrome

Application of intraoperative electrocorticography in bypass surgery for adult moyamoya disease: a preliminary study

Sagittal splitting of the temporalis muscle for encephalo-myo-synangiosis to prevent ischemic complications due to a swollen temporalis muscle without inhibiting collateral developments in patients with moyamoya disease

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