Efficacy assessment of superficial temporal artery–middle cerebral artery bypass surgery in treating moyamoya disease from a hemodynamic perspective: a pilot study using computational modeling and perfusion imaging,Acta Neurochirurgica

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Efficacy assessment of superficial temporal artery–middle cerebral artery bypass surgery in treating moyamoya disease from a hemodynamic perspective: a pilot study using computational modeling and perfusion imaging
Acta Neurochirurgica ( IF 1.9 ) Pub Date : 2023-01-03 , DOI: 10.1007/s00701-022-05455-9
Xinhong Wang ₁ , Haipeng Liu ₂ , Mengxi Xu ₁ , Cong Chen ₁ , Linlin Ma ₁ , Fangyu Dai ₃

Affiliation

Background

Superficial temporal artery–middle cerebral artery (STA–MCA) bypass is a common surgery in treating moyamoya disease (MMD) with occluded MCA. Computational fluid dynamics (CFD) simulation might provide a simple, non-invasive, and low-cost tool to evaluate the efficacy of STA–MCA surgery.

Aim

We aim to quantitatively investigate the treatment efficacy of STA–MCA surgery in improving the blood flow of MMD patients using CFD simulation.

Methods

This retrospective study included 11 MMD patients with occlusion around proximal MCA who underwent STA–MCA bypass surgery. CFD simulation was performed using patient-specific blood pressure and postoperative artery geometry. The volumetric flow rates of STA and the bypass, average flow velocity in the proximal segment of transcranial bypass, transcranial pressure drop, and transcranial flow resistance were measured and compared with a postoperative increment of cerebral blood flow (CBF) in MCA territories derived from perfusion imaging. Per-branch pressure drop from model inlet to bypass branch outlet was calculated.

Results

The volumetric flow rates of STA and the bypass were 80.84 ± 14.54 mL/min and 46.03 ± 4.21 mL/min. Average flow velocity in proximal bypass, transcranial pressure drop, and transcranial flow resistance were 0.19 ± 0.07 m/s, 3.72 ± 3.10 mmHg, and 6.54 ± 5.65 10⁻⁸ Pa s m⁻³. Postoperative mean increment of CBF in MCA territories was 16.03 ± 11.72 mL·100 g⁻¹·min⁻¹. Per-branch pressure drop was 10.96 ± 5.59 mmHg and 7.26 ± 4.25 mmHg in branches with and without stenosis.

Conclusions

CFD simulation results are consistent with CBF observation in verifying the efficacy of STA–MCA bypass, where postoperative stenosis may influence the hemodynamics.

中文翻译：

从血液动力学角度评估颞浅动脉-大脑中动脉旁路手术治疗烟雾病的疗效：使用计算模型和灌注成像的初步研究

背景

颞浅动脉-大脑中动脉 (STA-MCA) 搭桥术是治疗烟雾病 (MMD) 且 MCA 闭塞的常见手术。计算流体动力学 (CFD) 模拟可能提供一种简单、无创且低成本的工具来评估 STA-MCA 手术的疗效。

目的

我们旨在使用 CFD 模拟定量研究 STA-MCA 手术在改善 MMD 患者血流方面的治疗效果。

方法

这项回顾性研究包括 11 名 MMD 患者，他们接受了 STA-MCA 搭桥手术，在近端 MCA 周围发生闭塞。使用患者特定的血压和术后动脉几何形状进行 CFD 模拟。测量 STA 和旁路的体积流速、经颅旁路近端段的平均流速、经颅压降和经颅血流阻力，并与术后灌注产生的 MCA 区域脑血流量 (CBF) 增量进行比较成像。计算了从模型入口到旁路支路出口的每个支路压降。

结果

STA 和旁路的体积流量分别为 80.84 ± 14.54 mL/min 和 46.03 ± 4.21 mL/min。近端旁路的平均流速、经颅压降和经颅流阻分别为 0.19 ± 0.07 m/s、3.72 ± 3.10 mmHg 和 6.54 ± 5.65 10 −8 Pa ^s m ⁻³。MCA 区域 CBF 的术后平均增量为 16.03 ± 11.72 mL·100 g ^-1 ·min ^-1。在有和没有狭窄的分支中，每个分支的压降分别为 10.96 ± 5.59 mmHg 和 7.26 ± 4.25 mmHg。