Regression of rnoyamoya vessels and hemodynamic changes after successful revascularization in childhood movarnova disease

Abstract

Successful revascularization improves ischemic symptoms in the pediatric patients with moyamoya disease. However, it is not clear whether the revascularization prevents future intracranial hemorrhage from the residual moyamoya vessels. The purpose of this study is to investigate perioperative morphological and hemodynamic changes in the moyamoya vessels. Four pediatric patients (age < 15 years old) with bilateral moyamoya disease were selected for this study. To quantify the number of moyamoya vessels, T1‐weighted transverse images at the level of the basal ganglia and the thalamus were selected and characteristic flow voids in the lentiform nucleus were counted. Resting CBF and cerebrovascular reserve capacity (CRC) were measured pre‐ and 1 year after surgery using Xenon‐CT CBF method with acetazolamide test. The ratio of deep CBF/kortical CBF was calculated as an index of hemodynamic stress distribution. The one‐year follow‐up studies showed that 1) the number of moyamoya vessels decreased on the operative side, but did not change on the nonoperative sides in all cases; 2) the ratio of deep CBFkortical CBF decreased on the operative sides, but did not change in the non‐operative sides; and 3) the CRC increased on both sides. This observation suggests the possibility that revascularization surgery may be effective for preventing the future risk of intracranial hemorrhage.

Optimal surgical treatment for moyamoya disease in adults: direct versus indirect bypass

“…6 Some authors have reported a benefit from revascularization in patients presenting with intracranial hemorrhage. 8,10,15,40 Although patients with nonatherosclerotic moyamoya disease and hemodynamic failure appear to benefit from surgical revascularization procedures, the optimal bypass technique has yet to be elucidated.…”

Comparison of Cerebral Blood Flow Data Obtained by Computed Tomography (CT) Perfusion with that Obtained by Xenon CT Using 320-Row CT

“…[9][10][11] It is defined as the ratio of the mean CBF in central ROI to the mean CBF in cortical ROI. In the present study, we let hdSD 5 [average value for region I (LN)]/[average value for regions B to F (MCA)].…”

Elevation of Cerebrospinal Fluid Levels of Basic Fibroblast Growth Factor in Moyamoya and Central Nervous System Disorders

“…STA to middle cerebral artery, MCA, anastomosis) revascularization procedures resulting in subsequent neovascularization have been noted to be accompanied by a regression of the compensatory basal moyamoya network. Although this finding suggests a dynamic and controlled balance be tween sprouting and regression of blood vessels in the brain parenchyma [12,13], the natural regression of this network as the disease progresses occasionally makes this cause-and-effect relationship unclear.…”