scholarly journals Intraoperative Blood Flow Analysis of Direct Revascularization Procedures in Patients with Moyamoya Disease

2010 ◽  
Vol 31 (1) ◽  
pp. 262-274 ◽  
Author(s):  
Marco Lee ◽  
Raphael Guzman ◽  
Teresa Bell-Stephens ◽  
Gary K Steinberg
Keyword(s):  
Blood Flow ◽  
Moyamoya Disease ◽  
Superficial Temporal Artery ◽  
Flow Analysis ◽  
Temporal Artery ◽  
Local Flow ◽  
Blood Flow Analysis ◽  
Revascularization Procedures ◽  
Internal Carotid Arteries ◽  
Very High

Moyamoya disease is characterized by the progressive stenosis and often occlusion of the terminal internal carotid arteries, which leads to ischemic and hemorrhagic injuries. The etiology is unknown and surgical revascularization remains the mainstay treatment. We analyzed various hemodynamic factors in 292 patients with moyamoya disease, representing 496 revascularization procedures, including vessel dimension and intraoperative blood flow, using a perivascular ultrasonic flowprobe. Mean middle cerebral artery (MCA) flow rate was 4.4±0.26 mL/min. After superficial temporal artery (STA)–MCA bypass surgery, flows at the microanastomosis were increased fivefold to a mean of 22.2±0.8 mL/min. The MCA flows were significantly lower in the pediatric (16.2±1.3 mL/min) compared with the adult (23.9±1.0 mL/min; P<0.0001) population. Increased local flow rates were associated with clinical improvement. Permanent postoperative complications were low (<5%), but very high postanastomosis MCA flow was associated with postoperative stroke (31.2±6.8 mL/min; P=0.045), hemorrhage (32.1±10.2 mL/min; P=0.045), and transient neurologic deficits (28.6±5.6 mL/min; P=0.047) compared with controls. Other flow and vessel dimension data are presented to elucidate the hemodynamic changes related to the vasculopathy and subsequent to surgical intervention.

Surgical treatment and perioperative management of moyamoya disease associated with glycogen storage disease Type 1a

2011 ◽  
Vol 7 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Yusuke Egashira ◽  
Jun C. Takahashi ◽  
Hiroyuki Ohnishi ◽  
Yukako Kawasaki ◽  
Masamune Higashigawa ◽  
...  
Keyword(s):  
Glycogen Storage Disease ◽  
Moyamoya Disease ◽  
Storage Disease ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Glycogen Storage Disease Type ◽  
Glycogen Storage ◽  
Disease Type ◽  
Old Japanese ◽  
Internal Carotid Arteries

The authors report a case of concurrent moyamoya disease and glycogen storage disease Type 1a that was successfully managed with bypass surgery. This 7-year-old Japanese girl, diagnosed with glycogen storage disease Type 1a at the age of 2 years, presented with repeated transient ischemic attacks. Cerebral angiography revealed severe stenosis at the terminal portions of the bilateral internal carotid arteries, with typical moyamoya vessels. The patient underwent superficial temporal artery–middle cerebral artery anastomosis and encephalomyosynangiosis bilaterally, in 2 staged procedures at an interval of 4 months. Despite perioperative administration of glucose, hypoglycemia and metabolic acidosis occurred after both surgeries. The symptoms were milder after the second surgery, in which an increased dose of glucose was used. The patient tolerated the perioperative conditions well under intensified medical treatment, and no further ischemic symptoms occurred.

Development of a Virtual Coil Model for Blood Flow Simulation in Coil-Embolized Aneurysms

2013 ◽  
Author(s):  
Tomohiro Otani ◽  
Satoshi Ii ◽  
Toshiyuki Fujinaka ◽  
Masayuki Hirata ◽  
Junko Kuroda ◽  
...  
Keyword(s):  
Blood Flow ◽  
Porous Media ◽  
Packing Density ◽  
Coil Embolization ◽  
Flow Analysis ◽  
Local Flow ◽  
Flow Vorticity ◽  
Porous Media Model ◽  
Significant Difference ◽  
Blood Flow Analysis

Hemodynamics is considered to be one of the indices to evaluate the effects of the treatment by coil embolization for cerebral aneurysms. For the sake of detailed analysis of hemodynamics in coil-embolized aneurysms, we develop a virtual coil model based on the mechanical theory that the coil deforms toward minimizing the elastic energy, and represent a realistic configuration of the embolized coils in the aneurysm by the insertion simulation. Then, the blood flow analysis is done by solving the N.S. and continuity equations numerically with the finite volume method using polyhedral mesh. The coil insertion simulation demonstrated that almost uniform distribution of the coil in the aneurysm was achieved at over 10% packing density of the coil. The blood flow analysis using the virtual coil model showed that the flow momentum inside the aneurysm was reduced to less than 10% by coil embolization with a packing density over 20%. In comparison to the simulation results using a porous media model for the embolized coil, there was no significant difference in the reduction ratio of the flow momentum in the aneurysm by coil embolization. However, local flow dynamics evaluated by the flow vorticity was different in the virtual coil model and the porous media model, in particular at the neck region of the aneurysm.

Pitfalls in the surgical treatment of moyamoya disease

1988 ◽  
Vol 68 (4) ◽  
pp. 537-543 ◽  
Author(s):  
Susumu Miyamoto ◽  
Haruhiko Kikuchi ◽  
Jun Karasawa ◽  
Izumi Nagata ◽  
Naohiro Yamazoe ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Content Type ◽  
Cerebral Ischemic ◽  
Revascularization Procedures ◽  
Scalp Arteries ◽  
Fine Print

✓ Eleven cases of moyamoya disease refractory to indirect non-anastomotic revascularization, including encephalomyosynangiosis in two, encephaloduroarteriosynangiosis in seven, and encephalomyoarteriosynangiosis in two, are described. The patients suffered from recurrent cerebral ischemic symptoms, and further operative intervention, including superficial temporal artery-middle cerebral artery anastomosis and intracranial omental transplantation, was performed. The choice of operative maneuver depended on the availability of scalp arteries and on the nature of the ischemic symptoms. Although indirect non-anastomotic revascularization procedures have the advantage of technical ease and most patients respond to these procedures alone, there are some patients like the 11 presented here who are not cured by such procedures. In such cases, direct anastomotic revascularization is necessary for the prevention of stroke.

Surgical management of moyamoya disease

2009 ◽  
Vol 26 (4) ◽  
pp. E7 ◽  
Author(s):  
Ali A. Baaj ◽  
Siviero Agazzi ◽  
Zafar A. Sayed ◽  
Maria Toledo ◽  
Robert F. Spetzler ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Surgical Options ◽  
Direct Bypass ◽  
Stenotic Vessel ◽  
Internal Carotid Arteries

Moyamoya disease (MMD) is a progressive, occlusive disease of the distal internal carotid arteries associated with secondary stenosis of the circle of Willis. Symptoms include ischemic infarcts in children and hemorrhages in adults. Bypass of the stenotic vessel(s) is the primary surgical treatment modality for MMD. Superficial temporal artery-to-middle cerebral artery bypass is the most common direct bypass method. Indirect techniques rely on the approximation of vascularized tissue to the cerebral cortex to promote neoangiogenesis. This tissue may be in the form of muscle, pericranium, dura, or even omentum. This review highlights the surgical options available for the treatment of MMD.

scholarly journals Reversible occlusion of donor vessel caused by mouth opening after superficial temporal artery–middle cerebral artery anastomosis in adult moyamoya patients

2015 ◽  
Vol 123 (3) ◽  
pp. 670-675 ◽  
Author(s):  
Toshiro Katsuta ◽  
Hiroshi Abe ◽  
Koichi Miki ◽  
Tooru Inoue
Keyword(s):  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Mouth Opening ◽  
Temporal Artery ◽  
Muscle Layer ◽  
Adult Patients ◽  
Bone Window

OBJECT The authors experienced an intriguing phenomenon in 2 adult patients with moyamoya disease. Mouth opening caused reversible occlusion of the donor superficial temporal artery (STA), and the patients exhibited transient cerebral ischemic symptoms. The aim of this study was to assess the incidence of such occlusion and the mechanism of this phenomenon. METHODS Twelve consecutive adult patients with moyamoya disease (15 affected sides) who underwent STA–middle cerebral artery anastomosis were included in this study. Ultrasound examination was performed more than 3 months postoperatively to determine whether mouth opening affected blood flow of the donor STA and led to any ischemic symptoms within 1 minute. Computed tomography angiography was performed during both mouth opening and mouth closing, when blood flow changes of the donor STA were recognized. RESULTS Under wide mouth opening, steno-occlusion of the donor STA occurred in 5 of 15 sides (33.3%). On 1 side (6.7%), complete occlusion induced ischemic symptoms. Steno-occlusion occurred by at least 2 mechanisms: either the stretched temporalis muscle pushed the donor STA against the edge of the bone window, or the redundant donor STA kinked when the muscle was stretched. CONCLUSIONS Even with temporary occlusion of the donor STA, ischemic symptoms seem to rarely occur. However, to avoid the “big bite ischemic phenomenon,” the authors recommend securing a sufficient distance between the donor STA and the edge of the bone window and avoiding a redundant course of the donor STA within the muscle layer.

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