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Relationship Between Successful Extracranial-Intracranial Bypass Surgeries and Ischemic White Matter Hyperintensities
Alhusain Nagm1, Tetsuyoshi Horiuchi2, Kiyoshi Ito2
1Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Al-Azhar University Faculty of Medicine-Nasr city, Cairo, Egypt.
Background And Purpose:
Few studies have described regression of white matter hyperintensities (WMHs); however, no studies have described their recurrence or fluctuation. Thus, we aimed to study the course of WMHs on fluid-attenuated inversion recovery (FLAIR) magnetic resonance image (MRI) after extracranial-intracranial (EC-IC) bypass surgery and its correlation with the clinical outcome.
Methods:
We enrolled perioperative FLAIR MRIs of 12 patients with WMHs who underwent EC-IC bypass surgeries because of ischemic-vascular stenosis with postoperative improvement of the cerebral blood flow confirmed by (123)I-iodoamphetamine single-photon emission computed tomography. Correlation between WMHs and cerebral blood flow was confirmed by perioperative single-photon emission computed tomography and diffusion-weighted imaging MRI. The WMHs were assessed visually with meticulous volumetric grading. Depending on postoperative changes among different grades, the WMHs course was determined to be improved, fluctuating, worsened, or unchanged. A statistical analysis was performed on the course of WMHs over time.
Results:
Imaging analysis was done with FLAIR MRI in 12 patients. The course of WMHs over time was 41.7% improvement, 33.3% fluctuation, 16.7% unchanged, and 8.3% worsening of the deep WMHs. After unilateral bypass surgery, 80% of the improved WMHs occurred bilaterally. Among patients with improved clinical outcomes, 16.7% showed improvement and 33.3% showed fluctuation, whereas in patients with unchanged clinical outcomes, 25% showed improvement of their WMHs on follow-up FLAIR MRIs.
Conclusions:
This study might be considered the first step to find a relationship between successful EC-IC bypass surgeries and the course of ischemic WMHs. It could also open the door for further studies to make more solid conclusions.
Insights
Extracranial-intracranial bypass surgery can lead to improvement or fluctuation in white matter hyperintensities (WMHs). This study explores the relationship between bypass surgery, WMH changes, and clinical outcomes in patients with ischemic-vascular stenosis.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- White matter hyperintensities (WMHs) are common in cerebrovascular disease.
- Limited research exists on WMH regression, recurrence, or fluctuation.
- Understanding WMH dynamics post-intervention is crucial for patient management.
Purpose of the Study:
- To investigate the course of WMHs on FLAIR MRI after EC-IC bypass surgery.
- To correlate WMH changes with clinical outcomes in patients with ischemic-vascular stenosis.
- To explore the potential for WMH improvement or fluctuation following bypass surgery.
Main Methods:
- Analysis of perioperative FLAIR MRI scans from 12 patients undergoing EC-IC bypass.
- WMHs were assessed visually and volumetrically.
- Correlation of WMH course (improved, fluctuating, unchanged, worsened) with cerebral blood flow and clinical outcomes.
Main Results:
- WMH improvement was observed in 41.7% of patients, with fluctuation in 33.3%.
- Improved WMHs often occurred bilaterally after unilateral bypass.
- Correlation between WMH course and clinical outcome varied, with some patients showing improvement or fluctuation alongside clinical improvement.
Conclusions:
- This study provides initial insights into the relationship between successful EC-IC bypass and WMH dynamics.
- Findings suggest EC-IC bypass may influence the course of ischemic WMHs.
- Further research is warranted to solidify conclusions on EC-IC bypass and WMH progression.
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