Application of magnetic resonance angiography navigation technology in target bypass of moyamoya disease surgery_West China Medical Journal

Authors：

CHEN Xinhua , WANG Yi , WU Lingyun , LI Wei , HANG Chunhua ,  YANG Yongbo

Department of Neurosurgery, Affiliated Drum Tower Hospital, Medical College, Nanjing University, Nanjing, Jiangsu 210008, P. R. China;

Corresponding author：

YANG Yongbo, Email: yangyongbo2000@163.com

Keywords：

Time of flight magnetic resonance angiography; moyamoya disease; target bypass

DOI：

10.7507/1002-0179.202205125

Video：

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Objective To explore the application value of time of flight magnetic resonance angiography (TOF-MRA) in target bypass surgery for moyamoya disease. Methods The data of patients with moyamoya disease in Affiliated Drum Tower Hospital, Medical College, Nanjing University between May 1 and August 30, 2020 were retrospectively analyzed. Patients were divided into navigation group and control group according to whether navigation technology was used during operation. All patients completed TOF-MRA evaluation before operation, and all patients completed surgical treatment. One week after operation, TOF-MRA was reviewed to evaluate the patency of anastomotic stoma. The intraoperative and postoperative conditions of the two groups were compared. Results Finally, 48 patients with moyamoya disease were included. 22 patients who used intraoperative navigation were included in the navigation group, and 26 patients with moyamoya disease who did not use intraoperative navigation in the same period were included in the control group. There was no significant difference between the two groups in gender, age, Suzuki stage before operation, proportion of posterior circulation involvement, proportion of bleeding type, proportion of hypertension and proportion of diabetes (P>0.05). The operation duration [(3.3±0.4) vs. (3.6±0.6) h] and postoperative hospital stay [(7.3±1.9) vs. (8.8±2.7) d] in the navigation group were shorter than those in the control group (P<0.05). There was no significant difference between the two groups in the proportion of patients who completed bypass surgery, the proportion of middle meningeal artery retained, the postoperative patency rate, the proportion of temporary dysfunction, and the proportion of serious complications (P>0.05). Conclusion TOF-MRA sequence combined with navigation technology can effectively guide the surgical scheme design and postoperative evaluation of moyamoya disease.

Citation： CHEN Xinhua, WANG Yi, WU Lingyun, LI Wei, HANG Chunhua, YANG Yongbo. Application of magnetic resonance angiography navigation technology in target bypass of moyamoya disease surgery. West China Medical Journal, 2023, 38(1): 34-38. doi: 10.7507/1002-0179.202205125 Copy

1.	Suzuki J, Takaku A. Cerebrovascular “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol, 1969, 20(3): 288-299.
2.	Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med, 2009, 360(12): 1226-1237.
3.	Hishikawa T, Sugiu K, Date I. Moyamoya disease: a review of clinical research. Acta Med Okayama, 2016, 70(4): 229-236.
4.	Shang S, Zhou D, Ya J, et al. Progress in moyamoya disease. Neurosurg Rev, 2020, 43(2): 371-382.
5.	Sun H, Wilson C, Ozpinar A, et al. Perioperative complications and long-term outcomes after bypasses in adults with moyamoya disease: a systematic review and meta-analysis. World Neurosurg, 2016, 92: 179-188.
6.	闫学强, 刘鹏飞, 李晓龙, 等. 直接搭桥与间接搭桥手术治疗成人烟雾病疗效及并发症的 Meta 分析. 中国微侵袭神经外科杂志, 2018, 23(4): 152-156.
7.	Nguyen VN, Motiwala M, Elarjani T, et al. Direct, indirect, and combined extracranial-to-intracranial bypass for adult moyamoya disease: an updated systematic review and meta-analysis. Stroke, 2022, 53(12): 3572-3582.
8.	Gupta SK, Narayanan R, Aggarwal A, et al. Outcome following surgical revascularization in patients of moyamoya disease with focus on graft patency and angiographic changes. Neurol India, 2021, 69(3): 620-627.
9.	Kikuta K, Takagi Y, Fushimi Y, et al. “Target bypass”: a method for preoperative targeting of a recipient artery in superficial temporal artery-to-middle cerebral artery anastomoses. Neurosurgery, 2006, 59(Suppl 2): ONS320-6, discussion ONS326-7.
10.	Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis, Health Labour Sciences Research Grant for Research on Measures for Infractable Diseases. Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis). Neurol Med Chir (Tokyo), 2012, 52(5): 245-266.
11.	Miyamoto S, Nagata I, Hashimoto N, et al. Direct anastomotic bypass for cerebrovascular moyamoya disease. Neurol Med Chir (Tokyo), 1998(Suppl 38): 294-296.
12.	廖煜君, 徐斌, 安庆祝, 等. 烟雾病脑血管重建手术中脑膜中动脉的保护. 中国神经精神疾病杂志, 2017, 43(10): 612-615.
13.	Edjlali M, Qiao Y, Boulouis G, et al. Vessel wall MR imaging for the detection of intracranial inflammatory vasculopathies. Cardiovasc Diagn Ther, 2020, 10(4): 1108-1119.
14.	Filimonova E, Ovsiannikov K, Rzaev J. Neuroimaging in moyamoya angiopathy: updated review. Clin Neurol Neurosurg, 2022, 222: 107471.
15.	Shurkhay VA, Goryaynov SA, Aleksandrova EV, et al. Navigation systems in neurosurgery. Zh Vopr Neirokhir Im N N Burdenko, 2016, 80(6): 107-114.
16.	Ren S, Wu W, Su C, et al. High-resolution compressed sensing time-of-flight MR angiography outperforms CT angiography for evaluating patients with moyamoya disease after surgical revascularization. BMC Med Imaging, 2022, 22(1): 64.
17.	Sato K, Yamada M, Kuroda H, et al. Time-of-flight MR angiography for detection of cerebral hyperperfusion syndrome after superficial temporal artery-middle cerebral artery anastomosis in moyamoya disease. AJNR Am J Neuroradiol, 2016, 37(7): 1244-1248.
18.	von Kummer R, Dzialowski I. Imaging of cerebral ischemic edema and neuronal death. Neuroradiology, 2017, 59(6): 545-553.
19.	Zhao WG, Luo Q, Jia JB, et al. Cerebral hyperperfusion syndrome after revascularization surgery in patients with moyamoya disease. Br J Neurosurg, 2013, 27(3): 321-325.
20.	Li J, Jin M, Sun X, et al. Imaging of moyamoya disease and moyamoya syndrome: current status. J Comput Assist Tomogr, 2019, 43(2): 257-263.
21.	Du L, Jiang H, Li J, et al. Imaging methods for surgical revascularization in patients with moyamoya disease: an updated review. Neurosurg Rev, 2022, 45(1): 343-356.

1. Suzuki J, Takaku A. Cerebrovascular “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol, 1969, 20(3): 288-299.
2. Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med, 2009, 360(12): 1226-1237.
3. Hishikawa T, Sugiu K, Date I. Moyamoya disease: a review of clinical research. Acta Med Okayama, 2016, 70(4): 229-236.
4. Shang S, Zhou D, Ya J, et al. Progress in moyamoya disease. Neurosurg Rev, 2020, 43(2): 371-382.
5. Sun H, Wilson C, Ozpinar A, et al. Perioperative complications and long-term outcomes after bypasses in adults with moyamoya disease: a systematic review and meta-analysis. World Neurosurg, 2016, 92: 179-188.
6. 闫学强, 刘鹏飞, 李晓龙, 等. 直接搭桥与间接搭桥手术治疗成人烟雾病疗效及并发症的 Meta 分析. 中国微侵袭神经外科杂志, 2018, 23(4): 152-156.
7. Nguyen VN, Motiwala M, Elarjani T, et al. Direct, indirect, and combined extracranial-to-intracranial bypass for adult moyamoya disease: an updated systematic review and meta-analysis. Stroke, 2022, 53(12): 3572-3582.
8. Gupta SK, Narayanan R, Aggarwal A, et al. Outcome following surgical revascularization in patients of moyamoya disease with focus on graft patency and angiographic changes. Neurol India, 2021, 69(3): 620-627.
9. Kikuta K, Takagi Y, Fushimi Y, et al. “Target bypass”: a method for preoperative targeting of a recipient artery in superficial temporal artery-to-middle cerebral artery anastomoses. Neurosurgery, 2006, 59(Suppl 2): ONS320-6, discussion ONS326-7.
10. Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis, Health Labour Sciences Research Grant for Research on Measures for Infractable Diseases. Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis). Neurol Med Chir (Tokyo), 2012, 52(5): 245-266.
11. Miyamoto S, Nagata I, Hashimoto N, et al. Direct anastomotic bypass for cerebrovascular moyamoya disease. Neurol Med Chir (Tokyo), 1998(Suppl 38): 294-296.
12. 廖煜君, 徐斌, 安庆祝, 等. 烟雾病脑血管重建手术中脑膜中动脉的保护. 中国神经精神疾病杂志, 2017, 43(10): 612-615.
13. Edjlali M, Qiao Y, Boulouis G, et al. Vessel wall MR imaging for the detection of intracranial inflammatory vasculopathies. Cardiovasc Diagn Ther, 2020, 10(4): 1108-1119.
14. Filimonova E, Ovsiannikov K, Rzaev J. Neuroimaging in moyamoya angiopathy: updated review. Clin Neurol Neurosurg, 2022, 222: 107471.
15. Shurkhay VA, Goryaynov SA, Aleksandrova EV, et al. Navigation systems in neurosurgery. Zh Vopr Neirokhir Im N N Burdenko, 2016, 80(6): 107-114.
16. Ren S, Wu W, Su C, et al. High-resolution compressed sensing time-of-flight MR angiography outperforms CT angiography for evaluating patients with moyamoya disease after surgical revascularization. BMC Med Imaging, 2022, 22(1): 64.
17. Sato K, Yamada M, Kuroda H, et al. Time-of-flight MR angiography for detection of cerebral hyperperfusion syndrome after superficial temporal artery-middle cerebral artery anastomosis in moyamoya disease. AJNR Am J Neuroradiol, 2016, 37(7): 1244-1248.
18. von Kummer R, Dzialowski I. Imaging of cerebral ischemic edema and neuronal death. Neuroradiology, 2017, 59(6): 545-553.
19. Zhao WG, Luo Q, Jia JB, et al. Cerebral hyperperfusion syndrome after revascularization surgery in patients with moyamoya disease. Br J Neurosurg, 2013, 27(3): 321-325.
20. Li J, Jin M, Sun X, et al. Imaging of moyamoya disease and moyamoya syndrome: current status. J Comput Assist Tomogr, 2019, 43(2): 257-263.
21. Du L, Jiang H, Li J, et al. Imaging methods for surgical revascularization in patients with moyamoya disease: an updated review. Neurosurg Rev, 2022, 45(1): 343-356.

West China Medical Journal

Application of magnetic resonance angiography navigation technology in target bypass of moyamoya disease surgery

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