title: First autopsy analysis of a neovascularized arterial network induced by indirect bypass surgery for moyamoya disease: case report.
abstract: The object of this study was to analyze the pathology of collateral vessels newly induced by indirect bypass surgery for moyamoya disease (MMD). An autopsy analysis was conducted on a 39-year-old woman with MMD who had died of a brainstem infarction. The patient had undergone bilateral indirect bypass surgeries 22 years earlier. Sufficient revascularization via bilateral external carotid arterial systems was confirmed by cerebral angiography before her death. Macroscopic observation of the operative areas revealed countless meandering vessels on the internal surface of the dura mater connected with small vessels on the brain surface and in the subpial brain tissue. Notably, microscopic analysis of these vessels revealed the characteristic 3-layer structure of an arterial wall. This autopsy analysis was the first to confirm that indirect bypass surgery had induced the formation of a new arterial network (arteriogenesis) and that this network had been maintained for more than 20 years to compensate for the chronic cerebral ischemia caused by the MMD.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Maki
authors.initials: M
authors.lastname: Mukawa
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Nariai
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Motoki
authors.initials: M
authors.lastname: Inaji
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Natsumi
authors.initials: N
authors.lastname: Tamada
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Maehara
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Matsushima
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Kikuo
authors.initials: K
authors.lastname: Ohno
authors.affiliation: Human Pathology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Negi
authors.affiliation: Human Pathology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
mesh_terms: D000328:Adult; D001160:Arterioles / Q000473:pathology; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D020526:Brain Stem Infarctions / Q000000981:diagnostic imaging / Q000473:pathology; D002531:Cerebellum / Q000098:blood supply; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D002908:Chronic Disease; D003097:Collateral Circulation / Q000502:physiology; D038524:Diffusion Magnetic Resonance Imaging; D004388:Dura Mater / Q000098:blood supply; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055806:Microvessels / Q000473:pathology; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018919:Neovascularization, Physiologic / Q000502:physiology*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology*
keywords: CBF = cerebral blood flow; CBV = cerebral blood volume; CPP = cerebral perfusion pressure; EDAS; MMD = moyamoya disease; MTT = mean transit time; OEF = oxygen extraction fraction; STA = superficial temporal artery; arteriogenesis; encephaloduroarteriosynangiosis; moyamoya disease; vascular disorders