Potential of Unilateral Combined Bypass Surgery to Accelerate Contralateral Radiological Progression in Pediatric Moyamoya Disease

Overview

Journal Quant Imaging Med Surg

Specialty Radiology

Date 2023 Oct 23

PMID 37869311

Authors

Jichang Luo

Yao Feng

Xia Lu

Shiyuan Fang

Shasha Zheng

Gao Zeng

Lin Yan

Bin Yang

Tao Wang

Liqun Jiao

Yumin Luo

Ziping Han

Yan Ma

Affiliations

Soon will be listed here.

Abstract

Background: Surgical cerebral revascularization is recommended for treating pediatric moyamoya disease (MMD). However, whether unilateral combined bypass surgery can cause disease progression on the contralateral side is uncertain. The study aimed to investigate the vascular architecture and regional cerebral blood flow (rCBF) status of patients with pediatric MMD after successful unilateral combined bypass surgery and to identify the possible risk factors.

Methods: Pediatric patients diagnosed with MMD and admitted to Xuanwu Hospital who underwent combined bypass surgery between 2019 and 2021 were enrolled. Digital subtraction angiography (DSA) and magnetic resonance imaging (MRI) with arterial spin labeling (ASL) were performed to investigate the vascular architecture and rCBF during surgery and at short-term follow-up. Suzuki's angiographic staging and moyamoya vessel grading system were both used. Progression was defined as an increase in either Suzuki stage or moyamoya vessel grade detected after unilateral surgery. All analyses were performed with conventional statistic methods.

Results: A total of 27 successive patients with a median age of 8 [interquartile range (IQR), 5-14] years old were identified. On the non-operated (non-OP) side, 11 (40.7%) patients demonstrated progression, all of whom showed an increase in the moyamoya vessel grade, and 5 also displayed Suzuki stage progression during the median 4.7 (IQR, 3.7-5.7) months follow-up. However, rCBF barely changed on the non-OP side compared to preoperation [preoperation: median, 49.6, (IQR, 42.9-61.1) mL/100 g/min; postoperation: median, 50.2, (IQR, 43.5-59.3) mL/100 g/min; P=0.445].

Conclusions: Combined bypass surgery might accelerate the radiological progression on the contralateral side, which occurs before the decline of rCBF. Those with earlier Suzuki stage MMD of the non-OP side are prone to rapid progression after unilateral combined revascularization.

Citing Articles

The effect of post-labeling delay on cerebral blood flow is influenced by age and sex: a study based on arterial spin-labeling magnetic resonance imaging.

Hu Y, Zhang K, Liu R Quant Imaging Med Surg. 2024; 14(7):4388-4402.

PMID: 39022245 PMC: 11250344. DOI: 10.21037/qims-23-1622.

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