Combined Direct and Indirect Bypass for Moyamoya: Quantitative Assessment of Direct Bypass Flow Over Time

BACKGROUND:The optimal revascularization strategy for symptomatic adult moyamoya remains controversial. Whereas direct bypass offers immediate revascularization, indirect bypass can effectively induce collaterals over time. OBJECTIVE:Using angiography and quantitative magnetic resonance angiography,...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Neurosurgery 2013-12, Vol.73 (6), p.962-968
Hauptverfasser: Amin-Hanjani, Sepideh, Singh, Amritha, Rifai, Hashem, Thulborn, Keith R, Alaraj, Ali, Aletich, Victor, Charbel, Fady T
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
Beschreibung
Zusammenfassung:BACKGROUND:The optimal revascularization strategy for symptomatic adult moyamoya remains controversial. Whereas direct bypass offers immediate revascularization, indirect bypass can effectively induce collaterals over time. OBJECTIVE:Using angiography and quantitative magnetic resonance angiography, we examined the relative contributions of direct and indirect bypass in moyamoya patients after combined direct superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass and indirect encephaloduroarteriosynangiosis (EDAS). METHODS:A retrospective review of moyamoya patients undergoing combined STA-MCA bypass and EDAS was conducted, excluding pediatric patients and hemorrhagic presentation. Patients with quantitative magnetic resonance angiography measurements of the direct bypass immediately and > 6 months postoperatively were included. Angiographic follow-up, when available, was used to assess EDAS collaterals at similar time intervals. RESULTS:Of 16 hemispheres in 13 patients, 11 (69%) demonstrated a significant (> 50%) decline in direct bypass flow at > 6 months compared with baseline, averaging a drop from 99 ± 35 to12 ± 7 mL/min. Conversely, angiography in these hemispheres demonstrated prominent indirect collaterals, in concert with shrinkage of the STA graft. Decline in flow was apparent at a median of 9 months but was evident as early as 2 to 3 months. CONCLUSION:In this small cohort, a reciprocal relationship between direct STA bypass flow and indirect EDAS collaterals frequently occurred. This substantiates the notion that combined direct/indirect bypass can provide temporally complementary revascularization. ABBREVIATIONS:EDAS, encephaloduroarteriosynangiosisMCA, middle cerebral arteryQMRA, quantitative magnetic resonance angiographySTA, superficial temporal artery
ISSN:0148-396X
1524-4040
DOI:10.1227/NEU.0000000000000139