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Salvage multiple burr hole surgery in patients with Moyamoya disease: efficacy evaluation using probabilistic independent component analysis of dynamic susceptibility contrast perfusion MRI

 Bio Joo  ;  Jinna Kim  ;  Jun Kyu Hwang  ;  Kyu-Won Shim  ;  Seung-Koo Lee 
 NEURORADIOLOGY, Vol.64(9) : 1737-1745, 2022-09 
Journal Title
Issue Date
Cerebral Revascularization* / methods ; Humans ; Magnetic Resonance Imaging / methods ; Moyamoya Disease* / diagnostic imaging ; Moyamoya Disease* / surgery ; Perfusion
Burr hole surgery ; Dynamic susceptibility contrast MRI ; Independent component analysis ; Moyamoya disease ; Perfusion MRI
Purpose: Multiple burr hole surgery is considered to be an option for achieving indirect revascularization in patients with ischemic Moyamoya disease (MMD). We aimed to investigate the efficacy of stand-alone multiple burr hole surgery for salvage revascularization in patients with MMD by assessing the hemodynamic changes via normalized time-to-peak (nTTP) analysis and independent component analysis (ICA) of preoperative and postoperative dynamic susceptibility contrast (DSC) perfusion MRI data.

Methods: The DSC perfusion MRI data of 25 hemispheres from 21 patients with MMD, who underwent multiple burr hole surgery for salvage revascularization due to persistent or recurrent symptoms after primary revascularization with modified encephaloduroarteriosynangiosis (mEDAS), were analyzed. The nTTP, which was measured using the region of interests covering the entire surgical hemisphere, was compared between the preoperative and postoperative images. ICA was used to compare the relative arterial and venous components of the surgical hemispheres between the respective preoperative and postoperative images.

Results: The median postoperative nTTP (1.80 s) was significantly shorter than the median preoperative nTTP (4.10 s) (P < 0.001). The postoperative relative arterial component of the surgical hemisphere (median: 0.04) was significantly higher than the preoperative relative arterial component (median: - 0.02, P < 0.001). In contrast, the postoperative relative venous component of the surgical hemisphere (median: - 0.05) was significantly lower than the preoperative value (median: 0.05, P < 0.001).

Conclusion: The improvement in cerebral perfusion parameters observed on postoperative DSC perfusion MRI demonstrated that stand-alone multiple burr hole surgery could be a favorable salvage revascularization technique after mEDAS failure in patients with ischemic MMD.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jinna(김진아) ORCID logo https://orcid.org/0000-0002-9978-4356
Shim, Kyu Won(심규원) ORCID logo https://orcid.org/0000-0002-9441-7354
Lee, Seung Koo(이승구) ORCID logo https://orcid.org/0000-0001-5646-4072
Joo, Bio(주비오) ORCID logo https://orcid.org/0000-0001-7460-1421
Hwang, Jun Kyu(황준규)
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