Individualised evaluation based on pathophysiology for moyamoya vasculopathy:application in surgical revascularisation  

作　　者：Xin Zhang Yu Lei Jiabin Su Chao Gao Yanjiang Li Rui Feng Ding Xia Peng Gao Yuxiang Gu Ying Mao 

机构地区：[1]Department of Neurosurgery,Huashan Hospital Fudan University,Shanghai,China [2]Department of Radiology,Huashan Hospital Fudan University,Shanghai,China

出　　处：《Stroke & Vascular Neurology》2024年第3期268-278,I0241-I0246,共17页卒中与血管神经病学（英文）

基　　金：supported by the National Natural Science Foundation of China(grant number 82171313);Shanghai Hospital Development Center(grant number SHDC2022CRD032);Shanghai Municipal Science and Technology Commission Project(grant number 19DZ1930304),ZJLab,and Shanghai Zhou Liangfu Medical Development Foundation'Brain Science and Brain Diseases Youth Innovation Program'.

摘　　要：Background Although bypass surgery is an effective treatment for moyamoya vasculopathy(MMV),the incidence of postoperative complications is still high.This study aims to introduce a novel evaluating system based on individualised pathophysiology of MMV,and to assess its clinical significance.Methods This multicentre,prospective study enrolled adult patients with MMV from Huashan Hospital,Fudan University and National Center for Neurological Disorders,China between March 2021 and February 2022.Multimodal neuroimages containing structural and functional information were used to evaluate personalised disease severity and fused to localise the surgical field,avoid invalid regions and propose alternative recipient arteries.The recipient artery was further selected intraoperatively by assessing regional haemodynamic and electrophysiological information.The preanastomosis and postanastomosis data were compared with assist with the postoperative management.Patients who received such tailored revascularisations were included in the novel group and the others were included in the traditional group.The 30-day surgical outcomes and intermediate long-term follow-up were compared.Results Totally 375 patients(145 patients in the novel group and 230 patients in the traditional group)were included.The overall complication rate was significantly lower in the novel group(p˂0.001).In detail,both the rates of postoperative infarction(p=0.009)and hyperperfusion syndrome(p=0.010)were significantly lower.The functional outcomes trended to be more favourable in the novel group,though not significantly(p=0.260).Notably,the proportion of good functional status was higher in the novel group(p=0.009).Interestingly,the preoperative statuses of perfusion and metabolism around the bypass area were significantly correlated with the occurrence of postoperative complications(P˂0.0001).Conclusions This novel evaluating system helps to identify appropriate surgical field and recipient arteries during bypass surgery for MMV to achieve better haemod

关 键 词：SURGICAL BYPASS metabolism 

分 类 号：R743[医药卫生—神经病学与精神病学]