title: Surgical revascularization reverses cerebral cortical thinning in patients with severe cerebrovascular steno-occlusive disease.
abstract: OBJECTIVE
  Chronic deficiencies in regional blood flow lead to cerebral cortical thinning without evidence of gross tissue loss at the same time as potentially negatively impacting on neurological and cognitive performance. This is most pronounced in patients with severe occlusive cerebrovascular disease in whom affected brain areas exhibit "steal physiology," a paradoxical reduction of cerebral blood flow in response to a global vasodilatory stimulus intended to increase blood flow. We tested whether surgical brain revascularization that eliminates steal physiology can reverse cortical thinning.
  
  
  METHODS
  We identified 29 patients from our database who had undergone brain revascularization with pre- and postoperative studies of cerebrovascular reactivity using blood oxygen(ation) level-dependent MRI and whose preoperative study exhibited steal physiology without MRI-evident structural abnormalities. Cortical thickness in regions corresponding to steal physiology, and where applicable corresponding areas in the normal hemisphere, were measured using Freesurfer software.
  
  
  RESULTS
  At an average of 11 months after surgery, cortical thickness increased in every successfully revascularized hemisphere (n=30). Mean cortical thickness in the revascularized regions increased by 5.1% (from 2.40 ± 0.03 to 2.53 ± 0.03; P<0.0001).
  
  
  CONCLUSIONS
  Successful regional revascularization and reversal of steal physiology is followed by restoration of cortical thickness.
authors.forename: Jorn
authors.initials: J
authors.lastname: Fierstra
authors.forename: David B
authors.initials: DB
authors.lastname: Maclean
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Fisher
authors.forename: Jay S
authors.initials: JS
authors.lastname: Han
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Mandell
authors.forename: John
authors.initials: J
authors.lastname: Conklin
authors.forename: Julien
authors.initials: J
authors.lastname: Poublanc
authors.forename: Adrian P
authors.initials: AP
authors.lastname: Crawley
authors.forename: Luca
authors.initials: L
authors.lastname: Regli
authors.forename: David J
authors.initials: DJ
authors.lastname: Mikulis
authors.forename: Michael
authors.initials: M
authors.lastname: Tymianski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002540:Cerebral Cortex / Q000098:blood supply* / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002561:Cerebrovascular Disorders / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D055815:Young Adult