Decreased cortical perfusion in areas with blood-brain barrier dysfunction in Moyamoya disease
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ORIGINAL ARTICLE - VASCULAR NEUROSURGERY - ISCHEMIA
Decreased cortical perfusion in areas with blood-brain barrier dysfunction in Moyamoya disease Xiaocheng Lu 1 & Yabo Huang 1 & Peng Zhou 1 & Pinjing Hui 1 & Zhong Wang 1 Received: 12 May 2020 / Accepted: 30 June 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Recently, several studies have focused on the relationship between blood-brain barrier (BBB) impairment and the etiology of Moyamoya disease (MMD). However, in vivo studies investigating about BBB impairment and cortical perfusion in MMD patients were really rare. Methods This study included 16 patients diagnosed with MMD and 9 patients with atherosclerotic cerebrovascular disease (ACVD); all of who were treated with superficial temporal artery–middle cerebral artery (STA-MCA) bypass. Cortical perfusion was assessed using intraoperative indocyanine green (ICG) videoangiography by calculating the blood flow index (BFI). In addition, we used sodium fluorescein (NaFl) to evaluate the permeability of BBB in vivo during operation. Results The results showed that BBB impairment in MMD patients was more significant than that in ACVD patients, whereas, the cortical perfusion was comparable between two groups. BFI was significantly improved after STA-MCA bypass both in the MMD group (post-operation vs pre-operation: 109.2 ± 67.7 vs 64.3 ± 35.0, p = 0.004) and the ACVD group (post-operation vs pre-operation: 137.6 ± 89.6 vs 90.8 ± 58.3, p = 0.015). Moreover, BFI was significantly decreased in the cortex with BBB impairment as compared with that in the cortex with intact BBB (impaired BBB vs intact BBB: 55.7 ± 26.5 vs 87.6 ± 55.1, p = 0.025). Following bypass, the cortical perfusion significantly improved in the area of BBB impairment (post-operation vs preoperation: 93.8 ± 75.2 vs 55.7 ± 26.5, p = 0.004), which was not observed in the BBB intact area (post-operation vs pre-operation: 92.4 ± 50.4 vs 87.6 ± 55.1, p = 0.58). Conclusion In summary, we observed that BBB impairment in MMD patients was more significant than that in ACVD patients. This study also demonstrated for the first time that cortical perfusion was significantly decreased in the cortex with BBB impairment as compared with that in the cortex with intact BBB in MMD patients. We also observed that After STA-MCA bypass, the cortical perfusion was significantly improved in the cortex with BBB impairment. These results may provide a new insight for BBB impairment and cortical perfusion in the etiology of MMD. Keywords Blood-brain barrier . Cortical perfusion . Moyamoya disease . Atherosclerotic cerebrovascular disease
Introduction Xiaocheng Lu and Yabo Huang contributed equally to this work. This article is part of the Topical Collection on Vascular Neurosurgery Ischemia Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04480-w) contains supplementary material, which is available to authorized users. * Yabo Huang [email protected] 1
Department of Neurosurgery & Bra
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