Evaluation of Preoperative Low-flow Areas in STA-MCA Bypass Surgery Using Vascular Fusion Map Image.

IF 0.9 3区医学 Q4 NEUROSCIENCES Neurology India Pub Date : 2024-09-01 Epub Date: 2024-10-19 DOI:10.4103/neurol-india.Neurol-India-D-23-00664

Riki Tanaka, Dragan Jankovic, Tomoko Katayama, Mai Okubo, Kento Sasaki, Takamitsu Tamura, Yasuhiro Yamada, Fuminari Komatsu, Yoko Kato

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Abstract

Background: The superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery requires an anastomosis of the STA to an MCA with diminished blood flow. However, identifying the precise location of the MCA with reduced flow preoperatively is challenging as it often remains nonvisualized. To address this issue, we developed a novel technique, the area target bypass (ATB) method, to infer the location of the responsible vessel for low-flow areas.

Objective: The cornerstone of the ATB method lies in the utilization of the vascular fusion map (VFM). The VFM integrates 3D perfusion and 3D vascular images, enabling simultaneous evaluation of cerebral surface vessels and regions with reduced blood flow. This study aimed to assess the efficacy of the STA-MCA bypass surgery adopting the ATB method.

Methods: Between August 2022 and March 2023, we conducted eight STA-MCA bypass surgeries using the ATB method. For each case, the VFM was generated using the MTT and DLY parameters, and blood flow improvement was evaluated based on the VFM score, determined by an average score from seven experts.

Results: In all cases, the target vessel was identified either preoperatively or during craniotomy, with postoperative patency of the STA-MCA bypass confirmed. Out of the eight cases, seven demonstrated improved blood flow with a VFM score exceeding 1. No complications were reported.

Conclusion: The introduction of the ATB method has proven its potential in accurately pinpointing optimal anastomosis sites.

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利用血管融合图图像评估STA-MCA搭桥手术术前低流量区域

背景：颞浅动脉-大脑中动脉（STA-MCA）搭桥手术需要将 STA 与血流减少的 MCA 吻合。然而，术前确定血流减少的 MCA 的精确位置具有挑战性，因为它通常无法被观察到。为了解决这个问题，我们开发了一种新技术--区域目标旁路（ATB）法，用于推断低流量区域的责任血管位置：ATB 方法的基石在于利用血管融合图（VFM）。血管融合图整合了三维灌注图像和三维血管图像，可同时评估脑表面血管和血流减少的区域。本研究旨在评估采用ATB方法的STA-MCA搭桥手术的疗效：方法：2022 年 8 月至 2023 年 3 月期间，我们采用 ATB 方法进行了 8 例 STA-MCA 搭桥手术。每个病例都使用 MTT 和 DLY 参数生成 VFM，并根据七位专家的平均评分确定的 VFM 分数评估血流改善情况：所有病例均在术前或开颅手术中确定了靶血管，术后证实了 STA-MCA 旁路的通畅。在 8 个病例中，7 个病例的血流得到改善，VFM 评分超过 1 分。无并发症报告：ATB方法的引入证明了其在精确定位最佳吻合部位方面的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology India 医学-神经科学

CiteScore

1.60

自引率

70.40%

发文量

434

审稿时长

2 months

期刊介绍： Neurology India (ISSN 0028-3886) is Bi-monthly publication of Neurological Society of India. Neurology India, the show window of the progress of Neurological Sciences in India, has successfully completed 50 years of publication in the year 2002. ‘Neurology India’, along with the Neurological Society of India, has grown stronger with the passing of every year. The full articles of the journal are now available on internet with more than 20000 visitors in a month and the journal is indexed in MEDLINE and Index Medicus, Current Contents, Neuroscience Citation Index and EMBASE in addition to 10 other indexing avenues. This specialty journal reaches to about 2000 neurologists, neurosurgeons, neuro-psychiatrists, and others working in the fields of neurology.