Analyse The Hemodynamic Change In Both Hemicerebrum After The Combined Revascularization For Moyamoya Disease

Objective: To study the difference change of hemodynamic parameters before and after combined revascularization for moyamoya disease and analyse the relationship of the change with age, gender, the pattern of onset and whether the reconstructed blood vessel is patency. The results will provide a clinical evidence for the next plan for moyamoya disease treated by combined revascularization.Materials and Methods: 30 patients who were diagnosed with moyamoya disease by digital subtraction angiography(DSA) or Magnetic Resonance Angiography(MRA) and treated by STA-MCA by pass and EDAMS in the department of neurosurgery, Tongji medical college, Huazhong university of science and technology from September 1st, 2013 to October 1st, 2015 were included in this research. We collected the clinical symptom and features when they were in hospital and Signal Discovery HD750 3.0T MR scanner of the Germany were used for scan and the contrast agent was Gd-BOPTA(multihance), putting the resulting imagine into GE Advantage Workstation for postprocession to obtain the parameters of cerebral blood flow(CBF),cerebral blood volume(CBV), mean transit time(MTT) and time to peak(TTP) of the different lobe included front lobe,temple lobe,parietal lobe and occipital lobe, before the operation and three months after operation. We choose the same similar place of the lobe before and after operation, avoiding the big vessels. Then the parameters of the front and temple lobe were compared with that of referred areas to get the relative parameters including r CBF, r CBV,r MTT and r TTP. Every patient undertook CTA examination three months ago after the surgery to assess whether the rebuilt vessels is patency. By comparing the index measured after the operation with that before the treatment, we got the change value like ΔCBF, ΔCBV, ΔMTT and ΔTTP. In order to assess the outcome of the combined surgery and explore the relation between the hamodynamic change and age, gender, the pattern of onset and the patency of reconstructed blood vessel, all of the data were taken for statistic analysis by SPSS 20.0 statistical software.Result: Compared with the data collected before the operation, the parameters of r CBF from operated hemicerebrum has improved greatly in all selected areas(P<0.05, CI:95%). The parameters of r CBV in different lobes change differently,with no significant difference(P>0.05, CI:95%). The indexes of r MTT and r TTP in the regions of interest shortens obviously relative to the indexes measured before surgery(P<0.05, CI:95%). The parameters of r TTP improved significantly after the combined operation with the value of P less than 0.01. When analyzing the opposite side of hemicerebrum, we found that the parameter of r MTT and r TTP in front lobe and parietal lobe has improve apparently(P<0.05, CI 95%), while there was no significant difference before and after the operation both in the indexes of r CBF and r CBV(P>0.05,CI 95%). In the temple lobe, the parameters of r MTT shows great difference in two periods and the other parameters demonstrate no statistic difference. Grouped by the pattern of onset, all the patients were divided into two parts: one with hemorrhagic MMD and another with ischemic-type MMD. According to the statistic analysis, in the hemorrhagic-type group, the parameters of ΔMTT of the parietal lobe and occipital lobe has improved greatly(P<0.05, CI 95%) and the parameters ofΔTTP in front lobe, temple lobe and parietal lobe shows significant difference compared with those of the ischemic-type group. As the CTA is noninvasive method which can give a direct and visible figures compared with DSA, all of the patients have this examination to assess the patency degree of the remodeled blood vessel. We classified them in two group: one with good remodeling blood vessel and the opposite one is anther group. However, there is insignificant difference between the two group after the combined revascularization operation in each parameters(P>0.05, CI 95%). The same result is found in analyzing the gender influencing the surgical outcome. Spearman’s correlation analysis show that the there is no significant difference,with the correlation coefficient r=0.149,0.332,0.340 between theΔTTP of the front lobe, temple lobe and parietal lobe respectively(P>0.05,CI 95%).Conclusion:(1) The combined revascularization improved the blood perfusion significantly not only in the operation cerebrum but also in the non-operated cerebrum, which can provided evidence for the next plan after operation.(2) The pattern of onset of moyamoya disease has an influence on the assessment of the surgical outcome and the ischemic-type MMD has more significantly improved than the hemorrhagic MMD. we should perform an operation earlier for the ischemic-type MMD.(3)CTA is a noninvasive and cheap method to check whether the reconstructed vessels is well rebuilt and the positive result is consistency with the results of PWI. A further assessment by PWI should be taken. If the vessel donot appear in the examination of CTA.