title: Identification of a hemodynamic parameter for assessing treatment outcome of EDAS in Moyamoya disease.
abstract: This work is a novel attempt to incorporate computational fluid dynamics (CFD) techniques in the analysis of hemodynamic parameters of Moyamoya disease (MMD). Highly prevalent in Asian countries, MMD is characterised by progressive occlusion of the intracranial Internal Carotid Arteries (ICA). We intend to identify a reliable hemodynamic parameter that can be used to gauge treatment outcome. This will aid surgeons in the perioperative management of MMD patients. We carried out CFD analysis on eight patients (5 female, 3 male) with MMD treated by EDAS (encephalo-duro-arterio-synangiosis) between 2011 and 2012. All the eight patients presented with haemorrhage, with subsequent 4-12 month follow-up done using Magnetic Resonance Angiography (MRA) to capture auto-remodelling. We calculated percentage change in flow rate and pressure drop indicator (ΡDI) across the Left and Right ICA. Pressure drop indicator (PDI) is defined as the difference of pressure reduction within the carotid arteries, measured at post-op and follow up, using patient specific inflow rates. The measured percentage flow change and pressure reduction showed an increase at follow up for improved patients (characterised by angiography according to the method of Matsushima), who did not develop any complications after surgery. The inverse was observed in patients who were clinically classified as no change and retrogressed (according to the method of Matsushima) cases post-operation. This elucidates that our findings have instituted a new parameter that may well play a critical role as an assistive clinical decision making tool in MMD.
authors.affiliation: The Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
authors.forename: Kaavya
authors.initials: K
authors.lastname: Karunanithi
authors.affiliation: Department of Neurosurgery, 307 Hospital, PLA, Beijing, China.
authors.forename: Cong
authors.initials: C
authors.lastname: Han
authors.affiliation: The Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
authors.forename: Chang-Joon
authors.initials: CJ
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, The Fifth Center Hospital of Tian Jin, Tianjin, China.
authors.forename: Wanchao
authors.initials: W
authors.lastname: Shi
authors.affiliation: Department of Neurosurgery, 307 Hospital, PLA, Beijing, China. Electronic address: duanlian307@sina.com.
authors.forename: Lian
authors.initials: L
authors.lastname: Duan
authors.affiliation: The Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia. Electronic address: yi.qian@mq.edu.au.
authors.forename: Yi
authors.initials: Y
authors.lastname: Qian
mesh_terms: D000328:Adult; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D002548:Cerebral Revascularization; D005260:Female; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D008954:Models, Biological; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D011184:Postoperative Period; D011312:Pressure; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult
keywords: CFD; Cerebrovascular blood flows; EDAS; MMD; PDI; Revascularization