Clinical Implications of the “Brush Sign” in Susceptibility-Weighted Imaging for Moyamoya Disease

2021 ◽  
pp. 1-9
Author(s):  
Junlin Lu ◽  
Yahui Zhao ◽  
Mingtao Li ◽  
Li Ma ◽  
Yu Chen ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Perioperative Management ◽  
Clinical Implications ◽  
Susceptibility Weighted Imaging ◽  
Surgical Revascularization ◽  
Surgical Risk ◽  
Independent Risk Factors ◽  
High Intensity Signal ◽  
Revascularization Surgery ◽  
Deep Medullary Veins

<b><i>Objective:</i></b> Infarction is one of the most common postoperative complications after surgical revascularization for moyamoya disease (MMD). Increased conspicuity of deep medullary veins (DMVs) on susceptibility-weighted imaging (SWI), known as “brush sign,” could predict the severity of MMD. This study aimed to reveal the features of the “brush sign” in preoperative SWI and to verify its relationship to postoperative infarction. <b><i>Methods:</i></b> Consecutive patients with MMD who had undergone cerebral revascularization surgery were included. Routine preoperative SWI was performed. The “brush sign” was defined according to the number of the conspicuous DMVs &#x3e; 5 detected on SWI. Postoperative infarctions were defined as the high-intensity signal on postoperative DWI images, with or without neurologic deficits. The modified Rankin scale (mRS) was applied to evaluate the prognosis of patients. <b><i>Results:</i></b> In the enrolled 100 hemispheres, 35 were presented with the “brush sign.” Patients with ischemic onset manifestation and previous infarction history tended to present with the “brush sign.” Multivariate analysis showed that the “brush sign” (OR 13.669; 95% CI, 1.747–106.967, <i>p</i> = 0.013) and decreased rCBF (OR 6.050; 95% CI, 1.052–34.799, <i>p</i> = 0.044) were independent risk factors of postoperative infarction. Besides, the “brush sign” showed a significant correlation with a higher mRS score at discharge (<i>p</i> = 0.047). <b><i>Conclusion:</i></b> The findings strongly suggest that the presence of the “brush sign” preoperatively can be a predictor of infarction after surgical revascularization for ischemic MMD. It may contribute to an improved surgical result through focused perioperative management based on appropriate surgical risk stratification.

Effects of Surgical Revascularization on Peripheral Artery Aneurysms in Moyamoya Disease: Report of Three Cases

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 463-468 ◽  
Author(s):  
Satoshi Kuroda ◽  
Kiyohiro Houkin ◽  
Hiroyasu Kamiyama ◽  
Hiroshi Abe
Keyword(s):  
Moyamoya Disease ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Intracranial Bleeding ◽  
Peripheral Artery ◽  
Surgical Revascularization ◽  
Beneficial Effects ◽  
Collateral Arteries ◽  
Lenticulostriate Artery ◽  
Collateral Vessels

Abstract OBJECTIVE AND IMPORTANCE The beneficial effects of surgical revascularization on rebleeding in moyamoya disease remain unclear. This report is intended to clarify the effects of surgical revascularization on peripheral artery aneurysms, which represent one of the causes of intracranial bleeding in moyamoya disease. CLINICAL PRESENTATION Findings for three female patients who experienced intracranial bleeding are presented. Cerebral angiography revealed that intracranial bleeding resulted from the rupture of peripheral artery aneurysms arising from dilated collateral vessels such as the lenticulostriate artery. INTERVENTION The patients successfully underwent superficial temporal artery-middle cerebral artery anastomosis combined with encephaloduromyoarteriosynangiosis. Angiography demonstrated obliteration of the peripheral artery aneurysms, together with the disappearance or decrease in caliber of the parent collateral arteries, after surgery. None of the patients experienced rebleeding during the follow-up period (up to 52 mo). CONCLUSION The results strongly suggest that surgical revascularization potentially improves cerebral circulation and decreases hemodynamic stress on collateral vessels, obliterating peripheral artery aneurysms.

Abstract WP171: Surgical Strategy And Results Of Additional Bypass For Patients With Moyamoya Disease Refractory To Previous Surgery

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Satoshi Kuroda ◽  
Naoki Akioka ◽  
Daina Kashiwazaki ◽  
Hideo Hamada ◽  
Naoya Kuwayama ◽  
...  
Keyword(s):  
Disease Progression ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Posterior Cerebral Artery ◽  
Cerebral Hemodynamics ◽  
Surgical Revascularization ◽  
Surgical Strategies ◽  
Cerebrovascular Events ◽  
Before And After

Introduction —It is well known that surgical revascularization can improve cerebral hemodynamics and prevent further ischemic cerebrovascular events in moyamoya disease. However, a certain subgroup of patients repeats ischemic attacks even after surgery because of insufficient surgery or disease progression during follow-up periods. Hypothesis —Relevant designs and techniques in additional bypass surgery can resolve ischemic cerebrovascular events in patients with moyamoya disease refractory to previous bypass surgery. Methods —This study included totally 7 patients (9 hemispheres) with moyamoya disease refractory to previous bypass surgery. There were 5 children and 2 adults. They underwent previous bypass surgery in Japan and Europe 6 to 240 months before admission. Based on precise clinical and radiological analysis, cerebrovascular events were considered to occur because of insufficient bypass surgery in 5 patients and disease progression in the ipsilateral posterior cerebral artery in 2. Surgical strategies included wide craniotomy to cover the area where cerebral hemodynamics is still impaired and appropriate bypass procedures such as STA-MCA anastomosis, OA-PCA anastomosis, and indirect bypass. Using [123]I-IMP SPECT or [15]O-gas PET, cerebral hemodynamics was precisely examined before and after surgery Results —Postoperative course was uneventful and cerebral hemodynamics significantly improved in all 7 patients. Postoperative cerebral angiography revealed that additional bypass provided collateral blood flow to ischemic area before surgery. Ischemic cerebrovascular events rapidly resolved in 5 patients and gradually decreased in 2. Conclusion —This study strongly suggests adequate surgical design and procedures can resolve ischemic cerebrovascular events in patients with moyamoya disease refractory to previous bypass surgery.

Indocyanine green visualization of middle meningeal artery before craniotomy during surgical revascularization for moyamoya disease

2017 ◽  
Vol 159 (3) ◽  
pp. 567-575 ◽  
Author(s):  
Nozomu Tanabe ◽  
Shusuke Yamamoto ◽  
Daina Kashiwazaki ◽  
Naoki Akioka ◽  
Naoya Kuwayama ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Moyamoya Disease ◽  
Middle Meningeal Artery ◽  
Surgical Revascularization ◽  
Meningeal Artery

scholarly journals Disappearance of a ruptured distal anterior choroidal artery aneurysm following surgical revascularization for moyamoya disease with hemorrhagic onset

Nosotchu ◽  
2012 ◽  
Vol 34 (3) ◽  
pp. 187-192 ◽  
Author(s):  
Keisuke Toyoda ◽  
Shuji fukuda ◽  
Shunsuke Ishizaka ◽  
Tomonori Takeshita ◽  
Kentaro Hayashi ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Artery Aneurysm ◽  
Anterior Choroidal Artery ◽  
Surgical Revascularization ◽  
Anterior Choroidal ◽  
Choroidal Artery

Abstract W P101: Surgical Revascularization Reverses Decreased Cerebral Oxygen Metabolism in Young Patients with Moyamoya Disease

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Satoshi Kuroda ◽  
Daina Kashiwazaki ◽  
Kiyohiro Houkin
Keyword(s):  
Cerebral Ischemia ◽  
Moyamoya Disease ◽  
Young Patients ◽  
Oxygen Metabolism ◽  
Cerebral Oxygen ◽  
Surgical Revascularization ◽  
Cerebral Oxygen Metabolism ◽  
Positron Emission ◽  
Pet Scans ◽  
Parenchymal Damage

Purpose: This prospective study was aimed to evaluate the effects of surgical revascularization on cerebral oxygen metabolism in moyamoya disease. Methods: This study included totally 41 patients who underwent STA-MCA anastomosis and indirect bypass for moyamoya disease between 2000 and 2011. There were 12 children and 29 adults. Totally 67 hemispheres underwent surgery. MR imaging and 15O-gas positron emission tomography (PET) were performed before and 3 to 4 months after surgery. Hemodynamic and metabolic parameters were precisely quantified. Results: Preoperative PET scans revealed that cerebral metabolic rate for oxygen (CMRO2) was kept normal in 15 hemispheres (22%), but decreased in other 52 (78%). The incidence did not differ between pediatric and adult patients. Pronounced cerebral ischemia was observed in all hemispheres with decreased CMRO2. After surgery, CMRO2 value significantly improved to the normal level in 20 (38%) of 52 hemispheres, but did not change in other 32 (62%). Multivariate analysis showed that the predictors for postoperative CMRO2 normalization were patient’s age (younger than 40 years) and no parenchymal damage on MRI. Conclusion: These findings strongly suggest that cerebral oxygen metabolism is often depressed in response to dense and chronic cerebral ischemia in moyamoya disease. The phenomenon may be advantageous to protect the involved hemispheres against ischemia. Surgical revascularization may readily normalize oxygen metabolism in young patients without any parenchymal damage.

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