Guiping Wan
Miao Hu
Tianshu Tao
Jianjian Zhang
*
Jincao Chen
*The final, formatted version of the article will be published soon.
ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
Volume 15 - 2024 |
doi: 10.3389/fneur.2024.1484224
This article is part of the Research Topic Stroke and Cerebrovascular Disease in young adults View all 13 articles
The significance of Postbypass Blood Flow Model in Side to Side Bypass for Moyamoya Disease in predicting postoperative Cerebral Hyperperfusion Syndrome
Provisionally accepted- Department of neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, Hubei Province, China
Objective：We previously developed the use of side to side(s-s) bypass for the treatment of adult moyamoya disease (MMD) and discovered several kinds of distinct blood flow models intraoperatively, which we observed through indocyanine green-video angiography (ICG-VA). The purpose of this paper was to investigate the correlation between blood flow model (BFM) identified in s-s bypass and the incidence of postoperative cerebral hyperperfusion syndrome (CHS) among patients with MMD. Methods: We analyzed 166 hemispheres from 153 patients diagnosed with MMD, including 118 hemispheres with s-s bypass and 48 with end to side(e-s) bypass. We categorized the enrolled patients into three pairs of comparison groups based on postoperative CHS(CHS or Non-CHS) in s-s bypass, blood flow models(BFM Ⅰ or BFM Ⅱ ) and surgical approach(s-s bypass or e-s bypass). Patients’ demographics and characteristics were compared between groups. Results: Among patients who developed CHS, the occurrence of BFM Ⅰ was more frequent than that of BFMⅡ（0. 154 VS 0.019, P=0.029<0.05) and no significant differences were noted in the remaining data. In the group of blood flow models, the proportion of patients with a history of cerebral hemorrhage was higher in BFM II compared to BFM I (0.062 VS 0.226, P=0.009<0.05), and the incidence of severity of ischemia was found to be higher in BFM I than in BFM II(0.774 VS 0.429, P=0.011<0.05), while the postoperative modified Rankin Scale(mRS) score and the Matsushima grade displayed no obvious difference. In comparison with the occurrence of CHS in e-s bypass group(7/48,0. 146), s-s bypass group had no difference(11/118,0.093;P=0.323>0.05), BFM Ⅰ group showed no discrepancy(10/65,0.154,P=0.906>0.05) while BFM Ⅱ group was different(1/53,0.019,P=0.047<0.05). Conclusions: The proportion of postoperative CHS occurring in BFMⅡ during s-s bypass was lower than that in e-s bypass and BFM Ⅰ. The postbypass blood flow model in s-s bypass may serve as a novel predictor for postoperative CHS.
Keywords: Moyamoya Disease, surgical procedures, Blood flow model, BFM, side to side bypass, Cerebral hyperperfusion syndrome (CHS)
Received: 21 Aug 2024; Accepted: 29 Oct 2024.
Copyright: © 2024 Wan, Hu, Yu, Xin, Tao, Quan, Zhang and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jianjian Zhang, Department of neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, 430071, Hubei Province, China
Jincao Chen, Department of neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, 430071, Hubei Province, China
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