Abstract WP414: Ultrasonographic Changes after Indirect Bypass Surgery in Pediatric Patients with Moyamoya Disease

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Shin-Joe Yeh ◽  
Sung-Chun Tang ◽  
Li-Kai Tsai ◽  
Ya-Fang Chen ◽  
Hon-Man Liu ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Pediatric Patients ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Cerebral Hypoperfusion ◽  
Mean Flow ◽  
Pronounced Increase ◽  
Intracranial Arteries

Background: The marked cerebral hypoperfusion caused by moyamoya disease (MMD) usually manifests as ischemic stroke or transient ischemic attack. The treatment of choice for MMD is extracranial-intracranial bypass surgery; however, the changes of ultrasonographic features following indirect bypass surgery are unknown. This study sought to characterize the ultrasonographic changes that result from indirect bypass surgery in pediatric patients with MMD. Methods: We prospectively recruited 15 pediatric MMD patients who had undergone a total of 19 indirect bypass surgeries (encephaloduroarteriosynangiosis, EDAS) and obtained the relevant clinical and radiological characteristics. Neurovascular ultrasonography of extracranial and intracranial arteries was performed pre-operatively and post-operatively at 1, 3, and 6 months. Results: Among the 15 patients (11 males, 4 females), the mean age was 10.4 ± 4.6 years. Among the extracranial arteries, the superficial temporal artery presented the most pronounced increase in flow velocity and decrease in flow resistance, beginning at 1 month post-op (all p<0.01). Among the large intracranial arteries, a significant increase in mean flow velocity was observed in the anterior cerebral artery since 3 months post-op (p<0.05). Conclusion: Significant hemodynamic changes were observed in pediatric MMD patients after EDAS surgery, as evidenced by periodic ultrasonographic assessment.

scholarly journals Low flow velocity in the middle cerebral artery predicting infarction after bypass surgery in adult moyamoya disease

2017 ◽  
Vol 126 (5) ◽  
pp. 1573-1577 ◽  
Author(s):  
Hoyeon Cho ◽  
Kyung Il Jo ◽  
Jua Yu ◽  
Je Young Yeon ◽  
Seung-Chyul Hong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Middle Cerebral Artery ◽  
Flow Velocity ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Early Stage ◽  
Low Flow ◽  
Mean Flow ◽  
Postoperative Mri

OBJECTIVEDirect and indirect bypass surgeries are recognized as the most effective treatments for preventing further stroke in adults with moyamoya disease (MMD). However, the risk factors for postoperative infarction after bypass surgery for MMD are not well established. Therefore, the objective of this study was to investigate the risk factors for postoperative infarction. In particular, the authors sought to determine whether transcranial Doppler (TCD) ultrasonography measurements of mean flow velocity (MFV) in the middle cerebral artery (MCA) could predict postrevascularization infarction.METHODSThe medical records of patients with MMD who underwent direct bypass surgery at the authors' institution between July 2012 and April 2015 were reviewed. The MFV in the MCA was measured with TCD ultrasonography and categorized as high (> 80 cm/sec), medium (40–80 cm/sec), and low (< 40 cm/sec). Postoperative MRI, including diffusion-weighted imaging, was performed for all patients within a week of their surgery. Angiographic findings were classified according to the Suzuki scale. Postrevascularization infarction was defined as any diffusion restriction on postoperative MRI scans. Postoperative neurological status was assessed through a clinical chart review, and the modified Rankin Scale was used to evaluate clinical outcomes.RESULTSOf 43 hemispheres in which bypass surgery for MMD was performed, 11 showed postrevascularization infarction. Ten of these hemispheres had low MFV and 1 had medium MFV in the ipsilateral MCA. In both univariate and multivariate analyses, a low MFV was associated with postrevascularization infarction (adjusted OR 109.2, 95% CI 1.9–6245.3). A low MFV was also statistically significantly associated with more advanced MMD stage (p = 0.02).CONCLUSIONSA low MFV in the ipsilateral MCA may predict postrevascularization infarction. Bypass surgery for MMD appears to be safe in early-stage MMD. Results of TCD ultrasonography provide clinical data on the hemodynamics in MMD patients before and after revascularization.

scholarly journals Application of FLOW 800 in extracranial-to-intracranial bypass surgery for moyamoya disease

2022 ◽  
Vol 6 (1) ◽  
pp. V16
Keyword(s):  
Cerebral Cortex ◽  
Surgical Treatment ◽  
Middle Cerebral Artery ◽  
Real Time ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Flow 800

The surgical treatment of moyamoya disease is heavily reliant upon a real-time understanding of cerebral hemodynamics. The application of FLOW 800 allows the surgeon to semiquantify the degree of perfusion to the cerebral cortex following extracranial-to-intracranial (EC-IC) bypass surgery. The authors present three illustrative cases demonstrating common intraoperative findings prior to and following anastomosis using FLOW 800. All patients were diagnosed by catheter angiogram with moyamoya disease and noninvasive imaging demonstrating hemispheric hypoperfusion. Superficial temporal artery (STA)–to–middle cerebral artery (MCA or M4) bypasses were performed to augment intracranial perfusion. The patients tolerated the procedures well and were discharged without event in stable neurological condition. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21191

Less Invasive Pedicled Omental-Cranial Transposition in Pediatric Patients With Moyamoya Disease and Failed Prior Revascularization

2013 ◽  
Vol 10 (1) ◽  
pp. 1-14 ◽  
Author(s):  
Ramon Navarro ◽  
Kevin Chao ◽  
Peter A. Gooderham ◽  
Matias Bruzoni ◽  
Sanjeev Dutta ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Pediatric Patients ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Pedicled Flap ◽  
Resonance Imaging ◽  
Major Treatment ◽  
Omental Transposition ◽  
The Brain ◽  
Better Than

Abstract BACKGROUND: Patients with moyamoya disease and progressive neurological deterioration despite previous revascularization pose a major treatment challenge. Many have exhausted typical sources for bypass or have ischemia in areas that are difficult to reach with an indirect pedicled flap. Omental-cranial transposition has been an effective, but sparingly used technique because of its associated morbidity. OBJECTIVE: We have refined a laparoscopic method of harvesting an omental flap that preserves its gastroepiploic arterial supply. METHODS: The pedicled omentum can be lengthened as needed by dividing it between the vascular arcades. It is transposed to the brain via skip incisions. The flap can be trimmed or stretched to cover ischemic areas of the brain. The cranial exposure is performed in parallel with pediatric surgeons. We performed this technique in 3 pediatric patients with moyamoya disease (aged 5-12 years) with previous superficial temporal artery to middle cerebral artery bypasses and progressive ischemic symptoms. In 1 patient, we transposed omentum to both hemispheres. RESULTS: Blood loss ranged from 75 to 250 mL. After surgery, patients immediately tolerated a diet and were discharged in 3 to 5 days. The ischemic symptoms of all 3 children resolved within 3 months postoperatively. Magnetic resonance imaging at 1 year showed improved perfusion and no new infarcts. Angiography showed excellent revascularization of targeted areas and patency of the donor gastroepiploic artery. CONCLUSION: Laparoscopic omental harvest for cranial-omental transposition can be performed efficiently and safely. Patients with moyamoya disease appear to tolerate this technique much better than laparotomy. With this method, we can achieve excellent angiographic revascularization and resolution of ischemic symptoms.

Development of Arteriovenous Fistula After Revascularization Bypass for Moyamoya Disease

2014 ◽  
Vol 11 (1) ◽  
pp. E202-E206 ◽  
Author(s):  
Abdullah H Feroze ◽  
Jacob Kushkuley ◽  
Omar Choudhri ◽  
Jeremy J Heit ◽  
Gary K Steinberg ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Arteriovenous Fistula ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
De Novo ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Fistula Formation

Abstract BACKGROUND AND IMPORTANCE Moyamoya disease is a rare cerebrovascular disorder often treated by direct and indirect revascularization bypass techniques as a result of a typically devastating disease course and poor response to medical therapy. In this report, we describe the formation and subsequent management of a de novo arteriovenous fistula identified in the setting of a patient treated with direct bypass surgery, a previously unreported phenomenon. CLINICAL PRESENTATION A 51-year-old woman presenting with Suzuki stage IV bilateral moyamoya disease underwent bilateral extracranial-to-intracranial superficial temporal artery--to--middle cerebral artery bypass without complication at our institution. At the 6-month follow-up, she demonstrated no evidence of residual neurological deficits or continued symptoms despite documentation of an arteriovenous fistula arising at the site of the right extracranial-to-intracranial bypass on routine follow-up cerebral angiography. CONCLUSION We present the first reported case of de novo arteriovenous fistula formation after superficial temporal artery-to-middle cerebral artery bypass for the treatment of moyamoya disease. Treatment of such iatrogenic arteriovenous fistulae fed by a patent bypass vessel may prove challenging without associated compromise of the bypass, meriting careful evaluation of all potential therapeutic options. The fistula described herein most likely occurred secondary to recanalization of a previously thrombosed vein of Trolard. This case demonstrates the possibility of arteriovenous fistula formation as a potential sequela of revascularization bypass surgery and lends support to the previously described traumatic origin of fistula formation.

Strategic tunnelling of superficial temporal artery during bypass surgery for moyamoya disease

2022 ◽  
Author(s):  
Bhanu Jayanand Sudhir ◽  
Arunkumar Karthikayan ◽  
Jamaludeen Mohammed Amjad ◽  
Keelara Gowda Arun
Keyword(s):  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Superficial Temporal Artery ◽  
Temporal Artery
Sign in / Sign up

Export Citation Format

Share Document