Yahui Zhao1, Junlin Lu1, Qian Zhang1,2, Yan Zhang1,2, Dong Zhang1,2, Rong Wang1,2, Yuanli Zhao3,4. 1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6th Tiantanxili, 100050, Beijing, China. 2. Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China. 3. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6th Tiantanxili, 100050, Beijing, China. zhaoyuanli@126.com. 4. Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China. zhaoyuanli@126.com.
Abstract
OBJECTIVE: Indirect bypass surgery, which induces spontaneous neoangiogenesis in ischemic brain tissue and improves cerebral blood flow, is an effective treatment for moyamoya disease (MMD). The time course of neoangiogenesis development has not yet been investigated. This study aimed to determine the critical period of neovascularization after indirect bypass in MMD patients. METHODS: Patients with MMD who underwent indirect bypass surgery at Peking University International Hospital between January 2015 and October 2017 were retrospectively reviewed. Surgically treated hemispheres with short-term (3-6 months) and long-term (1 year) follow-up digital subtraction angiography (DSA) were included. The effects of revascularization were evaluated on lateral and anteroposterior views using angiography and compared between two follow-ups of the same hemisphere. RESULTS: This study included 25 hemispheres from 24 MMD patients (mean age: 22.48 ± 14.83 years), among whom 13 were pediatric patients and 12 were adults. Qualitative measurements including the Matsushima scale and coverage of neoangiogenesis on anteroposterior views were not significantly different between the short term and long term (P = 0.083 and P = 0.157, respectively). Quantitative measurements including the greatest width and height of the area covered by neovascularization on lateral views of DSA and the greatest depth of neovascularization penetration on anteroposterior views (P = 0.488, 0.298 and 0.527, respectively) were also not significantly different. The mean count of newly formed veins was more at long-term than short-term follow-up (5.5 ± 2.5 vs. 5.1 ± 2.4, P = 0.005). Subgroup analysis of pediatric patients and adults yielded the same results as in the whole series. CONCLUSION: After indirect bypass surgery, the major time window of arterial neoangiogenesis development was within 6 months after surgery. The general effect of revascularization was very similar in the short and long term; therefore, a follow-up angiography scheduled at 6 months after surgery is recommended. Growth of veins might continue after 6 months.
OBJECTIVE: Indirect bypass surgery, which induces spontaneous neoangiogenesis in ischemic brain tissue and improves cerebral blood flow, is an effective treatment for moyamoya disease (MMD). The time course of neoangiogenesis development has not yet been investigated. This study aimed to determine the critical period of neovascularization after indirect bypass in MMD patients. METHODS:Patients with MMD who underwent indirect bypass surgery at Peking University International Hospital between January 2015 and October 2017 were retrospectively reviewed. Surgically treated hemispheres with short-term (3-6 months) and long-term (1 year) follow-up digital subtraction angiography (DSA) were included. The effects of revascularization were evaluated on lateral and anteroposterior views using angiography and compared between two follow-ups of the same hemisphere. RESULTS: This study included 25 hemispheres from 24 MMD patients (mean age: 22.48 ± 14.83 years), among whom 13 were pediatric patients and 12 were adults. Qualitative measurements including the Matsushima scale and coverage of neoangiogenesis on anteroposterior views were not significantly different between the short term and long term (P = 0.083 and P = 0.157, respectively). Quantitative measurements including the greatest width and height of the area covered by neovascularization on lateral views of DSA and the greatest depth of neovascularization penetration on anteroposterior views (P = 0.488, 0.298 and 0.527, respectively) were also not significantly different. The mean count of newly formed veins was more at long-term than short-term follow-up (5.5 ± 2.5 vs. 5.1 ± 2.4, P = 0.005). Subgroup analysis of pediatric patients and adults yielded the same results as in the whole series. CONCLUSION: After indirect bypass surgery, the major time window of arterial neoangiogenesis development was within 6 months after surgery. The general effect of revascularization was very similar in the short and long term; therefore, a follow-up angiography scheduled at 6 months after surgery is recommended. Growth of veins might continue after 6 months.
Authors: Hai Sun; Christopher Wilson; Alp Ozpinar; Sam Safavi-Abbasi; Yan Zhao; Peter Nakaji; John E Wanebo; Robert F Spetzler Journal: World Neurosurg Date: 2016-05-02 Impact factor: 2.104
Authors: Luke Macyszyn; Mark Attiah; Tracy S Ma; Zarina Ali; Ryan Faught; Alisha Hossain; Karen Man; Hiren Patel; Rosanna Sobota; Eric L Zager; Sherman C Stein Journal: J Neurosurg Date: 2016-07-29 Impact factor: 5.115