Cerebral glucose metabolism changes in chronic ischemia patients following subcranial-intracranial bypass
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ORIGINAL ARTICLE
Cerebral glucose metabolism changes in chronic ischemia patients following subcranial-intracranial bypass Zaitao Yu 1 & Xiangen Shi 2 & Zhongqing Zhou 2 & Yang Yang 2 & Pengbo Li 2 & Yuqi Zhang 1 Received: 16 May 2019 / Revised: 15 August 2019 / Accepted: 4 September 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract The use of the internal maxillary artery (IMA) in intracranial artery bypass or subcranial-intracranial (SC-IC) bypass has recently been described as an alternative to traditional bypass. This study explores cerebral glucose metabolism characteristics of SC-IC bypass. Ten crescendo transient ischemic attack (TIA) patients with chronic occlusion of the middle cerebral artery (MCA) received bypass surgery of IMA with the radial artery graft (RAG) to the branch of MCA. The graft’s flow volume (FV) was measured by operative intraoperative duplex ultrasonography. Positron emission tomography (PET)/computed tomography (CT) was used to calculate the preoperational and postoperational average of the standard uptake value (SUVavg) of the 18-fluoro-2deoxy-D-glucose (18F-FDG) in the region of interest (ROI). The asymmetric index (AI) is recommended to reflect the SUVavg changes, and subsequently, cerebral glucose metabolism changes are supposedly clarified. Patent IMA-RAG-MCA bypass in ten chronic ischemia patients was confirmed by angiography after surgery. The intraoperative FV measurement value was 65.64 ± 10.52 (58.11–73.17) ml/min. Before the operation, the SUVavg of the ROI in the ischemic hemisphere (4.76 ± 2.35 (3.08–6.04)) clearly decreased compared to the one (5.99 ± 2.63 (4.11–7.87)) in the contralateral mirror region (P = 0.003). The result of AI of preoperation minus AI of postoperation was more than 10% (P = 0.031), which indicated suspicious significant changes in cerebral metabolism. All symptoms of study patients having crescendo ischemia were resolved in 1 month after the operation. In the cerebral hypoperfusion territory, uptake of 18F-FDG deceased. Improving the flow volume via SC-IC bypass makes available an elevated uptake of 18F-FDG. Keywords Ischemic cerebrovascular diseases . Subcranial-intracranial bypass . Cerebral glucose metabolism . 18F-FDG PET/CT
Introduction Since conventional extracranial-intracranial (EC-IC) bypass was first reported by Yasagil in 1967 [19], it has gained popularity for the treatment of aneurysms, moyamoya disease, and ischemic cerebrovascular diseases. The report of EC-IC bypass in the treatment of ischemic cerebrovascular diseases in 1985 [14, 15] and the Carotid Occlusion Surgery Study (COSS) in 2011 [11] stated that the surgery did not confer additional benefit compared to conservative drug therapy.
* Yuqi Zhang [email protected] 1
Department of Neurosurgery, Yu Quan Hospital, Tsinghua University, No. 5 Shijingshan Rd, Shijingshan District, Beijing 100040, China
2
Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
However, this procedure ameliorated the oxygen metabolis
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