Pedicled temporoparietal fascial flap for combined revascularization in adult moyamoya disease

Rāviņa, Kristīne; Rennert, Robert C.; Strickland, Ben A.; Chien, Mark; Carey, Joseph N.; Russin, Jonathan J.

doi:10.3171/2018.5.jns18938

Cited by 3 publications

(4 citation statements)

References 40 publications

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“…To date, the underlying mechanisms of MMD have remained to be fully elucidated. Existing studies on MMD have focused on its treatment and prognosis [3][4][5][6]. Nevertheless, evidence regarding the relationship between metabolic anomalies and MMD is limited [7].…”

Section: Introductionmentioning

confidence: 99%

Serum Uric Acid and Triglycerides in Chinese Patients with Newly Diagnosed Moyamoya Disease: A Cross-Sectional Study

Feng

et al. 2019

BioMed Research International

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Background. Evidence regarding the relationship between serum uric acid and triglycerides is limited. Therefore, the specific objective of this study was to investigate whether serum uric acid was independently related to triglycerides in Chinese patients with newly diagnosed moyamoya disease after adjusting for other covariates. Methods. The present study was a cross-sectional study. A total of 261 Chinese patients with newly diagnosed moyamoya disease were recruited from a hospital in China from 24 March 2013 to 24 December 2018. The independent variable and the dependent variable were serum uric acid measured at baseline and triglycerides, respectively. The covariates involved in this study included age, sex, body mass index, smoking status, and alcohol consumption. Results. The average age of the 227 selected participants was 47.5 ± 12.6 years old, and approximately 48.5% of them were male. The results of the fully adjusted linear regression showed that serum uric acid (10 μmol/L) was positively associated with triglycerides (mmol/L) after adjusting for confounders (β 0.048, 95% CI 0.032, 0.064). Conclusions. In patients with moyamoya disease, there seemed to be a positive association between serum uric acid and triglycerides.

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Section: Introductionmentioning

confidence: 99%

Serum Uric Acid and Triglycerides in Chinese Patients with Newly Diagnosed Moyamoya Disease: A Cross-Sectional Study

Feng

et al. 2019

BioMed Research International

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“…Ravina et al separated the STA from the TPFF and then disassociated the TPFF in a butterfly-like morphology ( 11 ). Matsushima grade A and B ratio was regarded as good long-term collateral circulation (71.5%), but the rate was inferior to the 97% observed in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…The most reported cases of MMA treated with TPFF were only 14 cases in 3 years ( 1 ). Although the study of Ravina et al confirmed the feasibility of TPFF for MMA ( 11 ), the criteria for inclusion was not rigorous. Compared with the previous study ( 1 ), our selected cases were more cautious, the mRS Score was ≤3, and the digital subtraction angiography (DSA) examination showed Suzuki angiographic III/IV stage, where smoke phenomenon was most obvious.…”

Section: Methodsmentioning

confidence: 99%

“…Pedicled temporoparietal fascial flap (TPFF) has been widely used for head and neck flap reconstruction in plastic surgery, due to its free, flexible, thin, and highly vascularized characteristics (9). In view of the above characteristics of the TPFF, some neurosurgeons have tried to replace the TPFF in the revascularization in MMA and succeeded (10)(11)(12). However, few reports have been published, as the technique is still in the exploratory stage.…”

Section: Introductionmentioning

confidence: 99%

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Modified pedicled temporoparietal fascial flap combined revascularization in adult moyamoya angiopathy

Zhang¹,

Tong²,

Wang³

et al. 2022

Ann Transl Med

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Background: Pedicled temporoparietal fascial flaps (TPFF), which are flexible, thin, and highly vascularized, have been tried for the moyamoya angiopathy (MMA) treatment. To reduce postoperative complications and improve prognosis, we performed surgical modification and followed up to observe the efficacy.Methods: From February 2018 and June 2022, the clinical data of 31 adult MMA patients who underwent the modified TPFF combined revascularization were collected. The clinical outcomes and complications of the patients were recorded until the cut-off date of follow-up. The primary endpoints were the magnetic resonance perfusion (MRP), modified Rankin Scale (mRS) scores, and Matsushima Grade; the secondary endpoints were the clinical symptom outcome and Postoperative complications. Descriptive statistics and rank sum test to assess the therapeutic effect of the modified TPFF combined revascularization for adult MMA treatment. Results:The clinical symptoms of MMA were alleviated in 26 patients and disappeared in five. In all patients, MRP showed improvement in cerebral perfusion on the operated side, and no deterioration or new cerebral infarction occurred during follow-up. Postoperative digital subtraction angiography (DSA) showed that the anastomotic site was patent, and the MMA collateral was decreased in all patients. Only 1 case (3%) of Matsushima grade C showed poor collateral compensation. The admission mRS score (1.54±0.66) of the ischemic MMA was significantly reduced compared with ≥6 months postoperatively (0.54±0.72, P<0.01).The admission mRS score (0.57±0.53) of the hemorrhagic MMA was reduced compared with ≥6 months postoperatively (0, P<0.05). Postoperative complications included epileptic seizures in 2 cases, a cerebral hyper-perfusion syndrome in 2 cases, intracranial rebleeding in 2 cases, skin necrosis in 1 case, and skin maceration in 1 case.Conclusions: Modified TPFF combined revascularization might be a feasible and safe surgical technique for MMA, but it is still necessary to increase the sample size and extend the follow-up time to evaluate its efficacy. Ischemic MMA may have a more significant prognostic benefit than hemorrhagic MMA by this surgery.

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Update on the anesthesia management in adult patients with moyamoya disease

Yang,

Mistry,

Ayrian

2024

Current Opinion in Anaesthesiology

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Purpose of review The anesthetic management of patients with Moyamoya disease (MMD) is challenging and continues to evolve. The goal of this review is to provide updated recommendations on the anesthetic management of adult MMD patients based on the relevant existing literature. Recent findings Key findings include the importance of aggressive hydration preoperatively to sustain cerebral perfusion. Hypertension induced intraoperatively may prevent cerebral hypoperfusion. Vigilance against cerebral hyperperfusion after revascularization is necessary, with specific blood pressure targets recommended. Fluid management should aim for normovolemia to mild hypervolemia. Maintaining body temperature helps prevent cerebral vasospasm induced by hypothermia. Maintaining adequate oxygen supply during surgery is crucial. In cases of ischemic stroke, managing hematocrit and oxygen carrying capacity is essential to prevent further ischemia. Extubation decisions should consider baseline neurological function, while postoperative normocapnia helps prevent cerebral hyperperfusion and hypertension. In intensive care, cautious blood pressure management is crucial to prevent secondary complications. Summary Strategies in the preoperative, intraoperative, and postoperative anesthetic management of MMD patients should aim to maintain adequate cerebral perfusion to prevent cerebral ischemia.

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Pedicled temporoparietal fascial flap for combined revascularization in adult moyamoya disease

Cited by 3 publications

References 40 publications

Serum Uric Acid and Triglycerides in Chinese Patients with Newly Diagnosed Moyamoya Disease: A Cross-Sectional Study

Serum Uric Acid and Triglycerides in Chinese Patients with Newly Diagnosed Moyamoya Disease: A Cross-Sectional Study

Modified pedicled temporoparietal fascial flap combined revascularization in adult moyamoya angiopathy

Update on the anesthesia management in adult patients with moyamoya disease

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