Hemodynamic improvement of anterior cerebral artery territory perfusion induced by bifrontal encephalo(periosteal) synangiosis in pediatric patients with moyamoya disease: a study with brain perfusion SPECT.
OBJECTIVE
The reinforcement of the anterior cerebral artery (ACA) territory perfusion is important for the future intellectual functioning of pediatric moyamoya disease (MMD) patients. To evaluate the hemodynamic improvement of the ACA territory, bifrontal encephalogaleo-(periosteal)synangiosis [EG(P)S] combined with encephaloduroarteriosynangiosis (EDAS) was compared with EDAS alone in pediatric MMD patients using brain perfusion SPECT.


METHODS
Among 36 patients (M:F = 16:20; mean age, 9.5 ± 3.0 years) who were surgically treated for MMD, EDAS was performed in 17 patients, and EDAS with bifrontal EG(P)S in 19 patients. Hemodynamic parameters consisting of basal cerebral perfusion, acetazolamide-challenge stress perfusion, and cerebrovascular reserve index were estimated using brain perfusion SPECT and probabilistic perfusion maps for the ACA and middle cerebral artery (MCA) territories. Cerebral angiography was performed to confirm revascularization.


RESULTS
Both the EDAS only (p = 0.04) and EDAS with EG(P)S group (p < 0.001) had significant improvements in cerebrovascular reserve of the ipsilateral MCA territory. The EDAS with EG(P)S group had significant improvements, not only in basal perfusion of the ipsilateral ACA territory (p = 0.03) but also in the cerebrovascular reserve of the bilateral ACA territories (p < 0.01). In parallel with the hemodynamic changes assessed by brain perfusion SPECT, neovascularization was noted in the ipsilateral MCA territory in both the EDAS only and EDAS with EG(P)S group, and in the ipsilateral ACA territory in the EDAS with EG(P)S group on the postoperative cerebral angiography.


CONCLUSIONS
EDAS with bifrontal EG(P)S induces significant improvements in the ACA and MCA territories, while EDAS generates significant improvements in the MCA territory only.
Department of Nuclear Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea. yosung99@hanmail.net
Yoo Sung
YS
Song
So Won
SW
Oh
Yu Keong
YK
Kim
Seung-Ki
SK
Kim
Kyu-Chang
KC
Wang
Dong Soo
DS
Lee
D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography; D002648:Child; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D055420:Perfusion Imaging; D012039:Regional Blood Flow; D012189:Retrospective Studies; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D019690:Technetium Tc 99m Exametazime