scholarly journals Application of Intraoperative Electrocorticography in Precise Bypass Surgery of Adult Moyamoya Disease: A Preliminary Study

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Yu Lei
Keyword(s):  
Postoperative Complications ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Regional Blood Flow ◽  
Beta Band ◽  
Surgical Revascularization ◽  
Traditional Group ◽  
Lower Amplitude ◽  
Significant Difference ◽  
Adult Moyamoya Disease

Abstract INTRODUCTION Postoperative complications of surgical revascularization are still difficult to predict because of poor knowledge of the underlying pathophysiological process. Since the aim of the surgery is to improve brain dynamics by increasing regional blood flow, we hypothesize that postoperative complications are determined by aberrant electrophysiological changes. Thus, we tried to evaluate the clinical significance of intraoperative electrocorticography (ECoG) in precise bypass surgery of adult moyamoya disease (MMD). METHODS Ninety-one adult patients operated by the same neurosurgeon in our institute was involved (26 in the precise group, 65 in the traditional group). Two 1 × 6 subdural electrode grids were placed parallelly on the middle frontal gyrus and superior temporal gyrus to record ECoG data continuously during the procedure in the precise group. For patients with several candidate recipient M4 arteries, we selected the one closer to the cortex with lower amplitude in the beta band and lower frequency. Postoperative complications, 1-mo follow-up NIHSS and MMSE scores were noted. The power spectral denstity (PSD) values, and its parameter of (delta + theta)/(alpha + beta) ratio (DTABR) were adopted as ECoG metrics. RESULTS No significant difference was noticed between the 2 groups in either postoperative NIHSS or MMSE, while postoperative complication of the precise group was significantly lower than that of the traditional group (P < .05). In the precise group, the post/preop DTABR ratio in the bypass area was significantly correlated with postoperative NIHSS (P = .014 r2 = 0.289) and MMSE changes (P = .007 r2 = 0.266). While in the remote area, neither postoperative NIHSS nor MMSE changes showed significant correlation with post/pre-op DTABR ratio (P > .05). Additionally, in the precise group, patients with postoperative complications exhibited significantly higher DTABR (1.67 ± 0.33 vs 0.95 ± 0.08, P = .003) and PSD of thata band than those without postoperative complications in only bypass area. CONCLUSION This study was the first to explain and guide surgical revascularization from the perspective of electrophysiology. Intraoperative ECoG was not only sensitive to reflect and predict postoperative neurological and cognitive performance, but also usable as a reference for recipient artery selection.

Abstract WP171: Surgical Strategy And Results Of Additional Bypass For Patients With Moyamoya Disease Refractory To Previous Surgery

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Satoshi Kuroda ◽  
Naoki Akioka ◽  
Daina Kashiwazaki ◽  
Hideo Hamada ◽  
Naoya Kuwayama ◽  
...  
Keyword(s):  
Disease Progression ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Posterior Cerebral Artery ◽  
Cerebral Hemodynamics ◽  
Surgical Revascularization ◽  
Surgical Strategies ◽  
Cerebrovascular Events ◽  
Before And After

Introduction —It is well known that surgical revascularization can improve cerebral hemodynamics and prevent further ischemic cerebrovascular events in moyamoya disease. However, a certain subgroup of patients repeats ischemic attacks even after surgery because of insufficient surgery or disease progression during follow-up periods. Hypothesis —Relevant designs and techniques in additional bypass surgery can resolve ischemic cerebrovascular events in patients with moyamoya disease refractory to previous bypass surgery. Methods —This study included totally 7 patients (9 hemispheres) with moyamoya disease refractory to previous bypass surgery. There were 5 children and 2 adults. They underwent previous bypass surgery in Japan and Europe 6 to 240 months before admission. Based on precise clinical and radiological analysis, cerebrovascular events were considered to occur because of insufficient bypass surgery in 5 patients and disease progression in the ipsilateral posterior cerebral artery in 2. Surgical strategies included wide craniotomy to cover the area where cerebral hemodynamics is still impaired and appropriate bypass procedures such as STA-MCA anastomosis, OA-PCA anastomosis, and indirect bypass. Using [123]I-IMP SPECT or [15]O-gas PET, cerebral hemodynamics was precisely examined before and after surgery Results —Postoperative course was uneventful and cerebral hemodynamics significantly improved in all 7 patients. Postoperative cerebral angiography revealed that additional bypass provided collateral blood flow to ischemic area before surgery. Ischemic cerebrovascular events rapidly resolved in 5 patients and gradually decreased in 2. Conclusion —This study strongly suggests adequate surgical design and procedures can resolve ischemic cerebrovascular events in patients with moyamoya disease refractory to previous bypass surgery.

Membrane Retraction Technique in Bypass Surgery for the Treatment of Adult Moyamoya Disease with Deep-Seated Recipient Artery

2020 ◽  
Vol 139 ◽  
pp. 294-297
Author(s):  
Gang Wang ◽  
Songtao Qi ◽  
Guozhong Zhang ◽  
Yunyu Wen ◽  
Mingzhou Li ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Recipient Artery ◽  
Adult Moyamoya Disease

Disruption of Cortical Arterial Network is Associated with the Severity of Transient Neurologic Events After Direct Bypass Surgery in Adult Moyamoya Disease

2017 ◽  
Vol 100 ◽  
pp. 311-315 ◽  
Author(s):  
Yusuke Egashira ◽  
Keita Yamauchi ◽  
Yukiko Enomoto ◽  
Noriyuki Nakayama ◽  
Shinichi Yoshimura ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Arterial Network ◽  
Direct Bypass ◽  
Adult Moyamoya Disease

Can Combined Bypass Surgery at Middle Cerebral Artery Territory Save Anterior Cerebral Artery Territory in Adult Moyamoya Disease?

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 431-438 ◽  
Author(s):  
Won-Sang Cho ◽  
Jeong Eun Kim ◽  
Jin Chul Paeng ◽  
Minseok Suh ◽  
Yong-il Kim ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Anterior Cerebral Artery ◽  
Middle Cerebral Artery Territory ◽  
Reservoir Capacity ◽  
Hemodynamic Changes ◽  
Adult Moyamoya Disease

Abstract BACKGROUND: Patients with moyamoya disease are frequently encountered with improved symptoms related to anterior cerebral artery territory (ACAt) and middle cerebral artery territory (MCAt) after bypass surgery at MCAt. OBJECTIVE: To evaluate hemodynamic changes in MCAt and ACAt after bypass surgery in adult moyamoya disease. METHODS: Combined bypass surgery was performed on 140 hemispheres in 126 patients with MCAt symptoms. Among them, 87 hemispheres (62.1%) accompanied preoperative ACAt symptoms. Clinical, hemodynamic, and angiographic states were evaluated preoperatively and approximately 6 months after surgery. RESULTS: Preoperative symptoms resolved in 127 MCAt (90.7%) and 82 ACAt (94.3%). Hemodynamic analysis of total patients showed a significant improvement in MCAt basal perfusion and reservoir capacity (P &lt; .001 and P = .002, respectively) and ACAt basal perfusion (P = .001). In a subgroup analysis, 82 hemispheres that completely recovered from preoperative ACAt symptoms showed a significant improvement in MCAt basal perfusion and reservoir capacity (P &lt; .001 and P = .05, respectively) and ACAt basal perfusion (P = .04). Meanwhile, 53 hemispheres that had never experienced ACAt symptoms significantly improved MCAt basal perfusion and reservoir capacity (P &lt; .001 and P = .05, respectively); however, no ACAt changes were observed. A qualitative angiographic analysis demonstrated a higher trend of leptomeningeal formation from MCAt to ACAt in the former subgroup (P = .05). During follow-up, no ACAt infarctions were observed. CONCLUSION: Combined bypass surgery at MCAt resulted in hemodynamic improvements in ACAt and MCAt, especially in patients with preoperative ACAt symptoms.

scholarly journals Overall Outcome after Surgical Revascularization in Childhood and Adult Moyamoya Disease.

2002 ◽  
Vol 30 (5) ◽  
pp. 369-374 ◽  
Author(s):  
Satoshi KURODA ◽  
Kiyohiro HOUKIN ◽  
Tatsuya ISHIKAWA ◽  
Naoki NAKAYAMA ◽  
Rina NANBA ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Surgical Revascularization ◽  
Adult Moyamoya Disease

scholarly journals Bypass surgery versus medical treatment for symptomatic moyamoya disease in adults

2017 ◽  
Vol 127 (3) ◽  
pp. 492-502 ◽  
Author(s):  
Dong-Kyu Jang ◽  
Kwan-Sung Lee ◽  
Hyoung Kyun Rha ◽  
Pil-Woo Huh ◽  
Ji-Ho Yang ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Cox Regression ◽  
Recurrent Stroke ◽  
Perioperative Complications ◽  
Adult Patients ◽  
Stroke Recurrence ◽  
Cox Regression Analysis ◽  
Significant Difference

OBJECTIVEIn this study the authors evaluated whether extracranial-intracranial bypass surgery can prevent stroke occurrence and decrease mortality in adult patients with symptomatic moyamoya disease (MMD).METHODSThe medical records of 249 consecutive adult patients with symptomatic MMD that was confirmed by digital subtraction angiography between 2002 and 2011 at 8 institutions were retrospectively reviewed. The study outcomes of stroke recurrence as a primary event and death during the 6-year follow-up and perioperative complications within 30 days as secondary events were compared between the bypass and medical treatment groups.RESULTSThe bypass group comprised 158 (63.5%) patients, and the medical treatment group comprised 91 (36.5%) patients. For 249 adult patients with MMD, bypass surgery showed an HR of 0.48 (95% CI 0.27–0.86, p = 0.014) for stroke recurrence calculated by Cox regression analysis. However, for the 153 patients with ischemic MMD, the HR of bypass surgery for stroke recurrence was 1.07 (95% CI 0.43–2.66, p = 0.887). For the 96 patients with hemorrhagic MMD, the multivariable adjusted HR of bypass surgery for stroke recurrence was 0.18 (95% CI 0.06–0.49, p = 0.001). For the treatment modality, indirect bypass and direct bypass (or combined bypass) did not show any significant difference for stroke recurrence, perioperative stroke, or mortality (log rank; p = 0.524, p = 0.828, and p = 0.616, respectively).CONCLUSIONSDuring the treatment of symptomatic MMD in adults, bypass surgery reduces stroke recurrence for the hemorrhagic type, but it does not do so for the ischemic type. The best choice of bypass methods in adult patients with MMD is uncertain. In adult ischemic MMD, a prospective randomized study to evaluate the effectiveness and safety of bypass surgery to prevent recurrent stroke is necessary.

Angiographic and clinical outcomes of non-patent anastomosis after bypass surgery in adult moyamoya disease

2019 ◽  
Vol 161 (2) ◽  
pp. 379-384 ◽  
Author(s):  
Seung Hwan Kim ◽  
Hyungon Lee ◽  
Minwook Yoo ◽  
Seongjin Jin ◽  
Sungjoon Lee ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Adult Moyamoya Disease

The natural clinical course of hemodynamically stable adult moyamoya disease

2015 ◽  
Vol 122 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Won-Sang Cho ◽  
Young Seob Chung ◽  
Jeong Eun Kim ◽  
Jin Pyeong Jeon ◽  
Young Je Son ◽  
...  
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Moyamoya Disease ◽  
Thyroid Disease ◽  
Stroke Risk ◽  
Clinical Status ◽  
Significant Difference ◽  
History Of ◽  
Adult Moyamoya Disease

OBJECT Moyamoya disease (MMD) is a rare cerebrovascular disease and its natural history is still unclear. The authors aimed to investigate the natural course of hemodynamically stable cases of adult MMD, with the analysis of stroke risk factors. METHODS Two hundred forty-one patients were included in this retrospective study. One hundred sixty-six (68.9%) were female, and mean age (± SD) at first visit was 41.3 ± 12.0 years (range 18–69 years). Unilateral involvement was identified in 33 patients, and 19 patients (7.9%) had a family history of MMD. According to the clinical presentations, patients were classified into hemorrhagic (n = 62, 25.7%), ischemic (n = 144, 59.8%), and asymptomatic (n = 35, 14.5%) groups. The mean duration of follow-up was 82.5 ± 62.9 months (range 7.3–347.0 months). RESULTS The annual stroke risk was 4.5%, and the annual risks of rebleeding in the hemorrhagic group and recurrent ischemic events in the ischemic group were 4.3% and 3.0%, respectively. There was no significant difference in cumulative stroke risk between the 3 groups (p = 0.461). Risk factors included thyroid disease for overall strokes (HR 2.56, 95% CI 1.16–5.67), initial hemorrhagic presentation for hemorrhagic strokes (HR 2.53, 95% CI 1.24–5.17), and initial ischemic presentation for ischemic strokes (HR 2.69, 95% CI 1.15–6.27). Familial MMD was a common risk factor for all types of stroke. Among the 3 clinical groups, the hemorrhagic group showed the worst clinical status at discharge and at most recent follow-up. Twenty-three patients (9.5%) eventually underwent revascularization surgery. CONCLUSIONS There was no statistically significant difference in the incidence of stroke in the different clinical groups; clinical status, however, was most severe in patients with hemorrhagic presentation. In patients who experienced stroke during the follow-up period, the stroke type tended to correspond to their initial presentation. Close follow-up is needed in patients with thyroid disease and a family history of MMD.

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