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

Abstract

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.

Unilateral combined bypass surgery might accelerate contralateral radiological progression in pediatric moyamoya disease

“…On the relationship between surgical treatment and MMD progression, Park et al conducted a retrospective study focusing on pediatric MMD patients treated by indirect revascularization and found that 20 of 34 patients (58.8%) had contralateral progression following surgery, whereas the mean follow-up duration of their cohort was long with 35.3 months (IQR, 18.1-100 months) [25]. Our previous studies have demonstrated that unilateral combined bypass surgery was associated with rapid radiological progression of contralateral vessels at short-term follow-up, resulting in rapid aggravation of main trunk stenosis and decreased cerebral blood ow on the non-OP side [11,13]. In the current study, we identi ed contralateral radiological progression in 11 pediatric patients (40.7%) within 3 to 6 months following unilateral combined bypass.…”

“…To address this issue, we have performed a series of study. Our previous study has demonstrated that rapid radiological progression of contralateral vessels at short-term follow-up after unilateral combined bypass surgery in pediatric MMD [13]. In this study, we aim to observe the progression pace on the non-OP side of pediatric MMD patients and explore its risk factors.…”

Potential of unilateral combined bypass surgery to accelerate contralateral radiological progression in pediatric moyamoya disease

“…To examine the relationship between surgical treatment and MMD progression, Park et al conducted a retrospective study focusing on patients with pediatric MMD treated by indirect revascularization and found that 20 of 34 patients (58.8%) had contralateral progression following surgery, and the mean follow-up duration was long (35.3 months, IQR, 18.1–100 months) ( 26 ). Our previous studies have demonstrated that unilateral combined bypass surgery is associated with rapid radiological progression of contralateral vessels at short-term follow-up and can result in the rapid aggravation of main trunk stenosis and decreased cerebral blood flow on the non-OP side ( 11 , 13 ). In the current study, we identified contralateral radiological progression in 11 pediatric patients (40.7%) within 3 to 6 months following unilateral combined bypass surgery.…”

“…A number of demographic and clinical variables, including age, sex, surgical side, angiographic findings, hemodynamic data, perioperative complications, and follow-up outcomes, were collected. Angiographic data including Suzuki stage, moyamoya vessel grade, and degree of neovascularization were evaluated independently by two neuroradiologists (Y Ma and X Lu), and any disagreement was settled by discussion with another neuroradiologist (B Yang) ( 13 ).…”

“…To address this issue, we performed a series of studies. Our previous research examined rapid radiological progression of contralateral vessels at short-term follow-up after unilateral combined bypass surgery in pediatric MMD ( 13 ). In study described here, we aimed to observe the progression pace on the non-OP side of patients with pediatric MMD and identify any related factors risk factors.…”