Difference in periventricular anastomosis in child and adult moyamoya disease: a vascular morphology study

Ryu, Jiwook; Hamano, Eika; Nakagawa, Masaki; Satow, Tetsu; Takahashi, Jun

doi:10.1007/s00701-020-04354-1

Cited by 12 publications

(7 citation statements)

References 23 publications

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“…Surgical procedures may induce stress on the regulation of hemodynamics, resulting in ischemic complications. Normal cerebral perfusion was found to be associated with hemorrhage in other studies of hemorrhagic MMD (19); thalamic anastomosis, choroidal anastomosis, and periventricular anastomosis play a crucial role in the hemorrhagic presentation of MMD (20)(21)(22). Revascularization may improve the dilation and branch extension of AChA-PCoA and reduce the rate of re-bleeding by decreasing the collateral circulation load (9).…”

Section: Discussionmentioning

confidence: 88%

Postoperative cerebral infarction after revascularization in patients with moyamoya disease: Incidence and risk factors

Wang

Jiang²,

Tang³

et al. 2022

Front. Neurol.

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ObjectivesCerebral infarction is the major complication of revascularization surgery in patients with moyamoya disease (MMD), and we analyzed the possible causes of cerebral infarction after revascularization surgery for MMD.MethodsMMD patients who were admitted and underwent surgical revascularization at Shanghai Huashan Hospital from January 2019 to December 2021 were retrospectively analyzed.ResultsA total of 815 patients and 890 revascularization surgeries (677 first revascularization surgeries and 213 second revascularization surgeries) were included in this study; 453 (50.9%) were performed on the left side and 437 (49.1%) on the right side, with 779 (87.5%) combined procedures and 111 (12.5%) indirect bypasses included. The mean patient age at the time of these procedures was 44.6 ± 11.7 years (range 6–72 years). Postoperative cerebral infarctions were observed in 46 (5.17%) surgeries, among which 31 occurred after left hemisphere revascularization surgeries, with an incidence of 6.84%, and 15 occurred after right hemisphere revascularization surgeries, with an incidence of 3.43%. Of these, 30 (65.2%) occurred in the operated hemispheres, 2 (4.3%) in the contralateral hemisphere and 13 (28.3%) in the bilateral hemisphere. There were 11 cases of massive infarction (23.9%). The incidence of postoperative infarction in patients undergoing the first revascularization was 6% (41/677) and 2.3% (5/213) in the second revascularization surgeries. Initial presentation as infarction (P < 0.001), initial presentation as hemorrhage (P < 0.001), hypertension (P = 0.018), diabetes (P = 0.006), 1st or 2nd surgery and surgical side (P = 0.007) were found to be related to postoperative cerebral infarction. Initial presentation as infarction (OR = 2.934, 95% CI 1.453–5.928, P = 0.003), initial presentation as hemorrhage (OR = 0.149, 95% CI 0.035–0.641, P = 0.011), and 1st or 2nd surgery and surgical side (OR = 1.66, 95% CI 1.106–2.491, P = 0.014) were independently associated with cerebral infarction after revascularization surgeries.ConclusionsIn patients with MMD undergoing surgical revascularization, initial presentation as infarction and first revascularization surgery performed on the left hemisphere are independent risk factors for postoperative cerebral infarction, whereas initial presentation as hemorrhage is a protective factor.

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Section: Discussionmentioning

confidence: 88%

Postoperative cerebral infarction after revascularization in patients with moyamoya disease: Incidence and risk factors

Wang

Jiang²,

Tang³

et al. 2022

Front. Neurol.

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“…These periventricular anastomoses in child ischemic MMD remained significantly higher than in the adult ischemic groups. 15 As for the collaterals from the anterior falx artery of external carotid artery, that should be an effective complement to the collaterals through the PCA-ACA leptomeningeal system which cannot meet the demand for blood supply of frontopolar and fronto-orbital cortex territory completely. 10 These collaterals should be protected carefully when performing the craniotomy.…”

Section: Discussionmentioning

confidence: 99%

Vascular Architecture Characters and Changes of Pediatric Moyamoya Disease after Combined Bypass Surgery

Xia

Zeng

et al. 2022

Neuropediatrics

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Objective We aimed to analyze the angioarchitecture characters and changes after combined bypass surgery (CBS) in pediatric moyamoya disease. Methods We retrospectively analyzed our database of consecutive patients with moyamoya angiopathy who received treatment. Only pediatric MMD cases aged between 3 to 19 years old whose pre- and post-operative imaging examinations including digital subtraction angiography and magnetic resonance imaging were enrolled in this study. The main trunk vessels stenosis and the collaterals from superficial-meningeal system and deep parenchymal system were evaluated before and after CBS. Results During short term follow-up period after the unilateral CBS, the stenosis of main trunk vessels both in operative (5.72.1 vs 6.81.8; P<0.001) and non-operative hemisphere (non-operative side 4.31.9 vs 5.72.1; P<0.001) progressed obviously. During the median follow-up period of 28.5 months after CBS, the decreasing of PCA-MCA anastomoses was much more significant (26 vs 6, P<0.001) than that of the PCA-ACA anastomoses (18 vs 19, P=0.807). Meanwhile, the subependymal anastomotic network could be relieved obviously (27 vs 2, P<0.001), while the inner thalamic and striatal anastomotic network had no significant change (31 vs 25, P=0.109). Conclusions The successful CBS could decrease the collaterals from PCA-MCA leptomeningeal system and the subependymal compensations in deep parenchyma significantly, while the main trunk stenosis would aggravate rapidly both in operative and non-operative hemisphere in short term after unilateral CBS. Therefore, strict and regular follow-up for the changes of vascular architecture and prompt surgical intervention for contralateral side might of benefit to pediatric MMD.

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“…Several previous studies investigated the distinctive effect of age in anastomosis vessels. Ryu et al 11 implicated that PA progression in pediatrics was more remarkable than in adult ischemic patients. The proportion of dilated LSA was reported to be higher in pediatric patients among Japanese.…”

Section: Discussionmentioning

confidence: 99%

Association of RNF213 Variants With Periventricular Anastomosis in Moyamoya Disease

Xue

Zeng

et al. 2022

Stroke

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Background: The pathogenic mechanisms of periventricular anastomosis (PA) in moyamoya disease remain unknown. Here, we aimed to describe the angiographic profiles of PA and their relationships with really interesting new gene (RING) finger protein 213 (RNF213) genotypes. Methods: We conducted a retrospective cohort study of moyamoya disease patients consecutively recruited between June 2019 and January 2021 in Beijing Tiantan Hospital, Capital Medical University, China. C-terminal region of RNF213 was sequenced. Angiographic characteristics of PA vessels (lenticulostriate artery, thalamotuberal artery, thalamoperforating artery, anterior choroidal artery, and posterior choroidal artery) were compared between different groups of RNF213 genotypes. The dilatation and extension of PA vessels were measured by using PA score (positive, score 1–5; negative, score 0). Multivariate regression analysis was conducted to assess variables associated with PA score. In addition, gene expression of RNF213 in human brain regions was evaluated from the Allen Human Brain Atlas. Results: Among 260 patients (484 hemispheres), 71.2% carried no RNF213 rare and novel variants, 20.0% carried p.R4810K heterozygotes, and 8.8% carried other rare and novel variants. PA scores in patients with p.R4810K and other rare and novel variants were significantly higher than in wild-type patients ( P <0.001). Age (odds ratio [OR], 0.958 [95% CI, 0.942–0.974]; P <0.001), platelet count (OR, 0.996 [95% CI, 0.992–0.999]; P =0.027), p.R4810K variant (OR, 2.653 [95% CI, 1.514–4.649]; P =0.001), other rare and novel variants (OR, 3.197 [95% CI, 1.012–10.094]; P =0.048), Suzuki stage ≥4 (OR, 1.941 [95% CI, 1.138–3.309]; P =0.015), and posterior cerebral artery involvement (OR, 1.827 [95% CI, 1.020–3.271]; P =0.043) were significantly correlated with PA score. High expression of RNF213 was detected in the periventricular area. Conclusions: RNF213 variants were confirmed to be associated with PA in moyamoya disease. Individuals with RNF213 p.R4810K heterozygotes and other C-terminal region rare variants exhibited different angiographic phenotypes, compared with wild-type patients.

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Difference in periventricular anastomosis in child and adult moyamoya disease: a vascular morphology study

Cited by 12 publications

References 23 publications

Postoperative cerebral infarction after revascularization in patients with moyamoya disease: Incidence and risk factors

Postoperative cerebral infarction after revascularization in patients with moyamoya disease: Incidence and risk factors

Vascular Architecture Characters and Changes of Pediatric Moyamoya Disease after Combined Bypass Surgery

Association of RNF213 Variants With Periventricular Anastomosis in Moyamoya Disease

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