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Published on: October 23, 2020
Decreased cortical perfusion in areas with blood-brain barrier dysfunction in Moyamoya disease
Xiaocheng Lu1, Yabo Huang2, Peng Zhou1
1Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China.
Background:
Recently, several studies have focused on the relationship between blood-brain barrier (BBB) impairment and the etiology of Moyamoya disease (MMD). However, in vivo studies investigating about BBB impairment and cortical perfusion in MMD patients were really rare.
Methods:
This study included 16 patients diagnosed with MMD and 9 patients with atherosclerotic cerebrovascular disease (ACVD); all of who were treated with superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Cortical perfusion was assessed using intraoperative indocyanine green (ICG) videoangiography by calculating the blood flow index (BFI). In addition, we used sodium fluorescein (NaFl) to evaluate the permeability of BBB in vivo during operation.
Results:
The results showed that BBB impairment in MMD patients was more significant than that in ACVD patients, whereas, the cortical perfusion was comparable between two groups. BFI was significantly improved after STA-MCA bypass both in the MMD group (post-operation vs pre-operation: 109.2 ± 67.7 vs 64.3 ± 35.0, p = 0.004) and the ACVD group (post-operation vs pre-operation: 137.6 ± 89.6 vs 90.8 ± 58.3, p = 0.015). Moreover, BFI was significantly decreased in the cortex with BBB impairment as compared with that in the cortex with intact BBB (impaired BBB vs intact BBB: 55.7 ± 26.5 vs 87.6 ± 55.1, p = 0.025). Following bypass, the cortical perfusion significantly improved in the area of BBB impairment (post-operation vs pre-operation: 93.8 ± 75.2 vs 55.7 ± 26.5, p = 0.004), which was not observed in the BBB intact area (post-operation vs pre-operation: 92.4 ± 50.4 vs 87.6 ± 55.1, p = 0.58).
Conclusion:
In summary, we observed that BBB impairment in MMD patients was more significant than that in ACVD patients. This study also demonstrated for the first time that cortical perfusion was significantly decreased in the cortex with BBB impairment as compared with that in the cortex with intact BBB in MMD patients. We also observed that After STA-MCA bypass, the cortical perfusion was significantly improved in the cortex with BBB impairment. These results may provide a new insight for BBB impairment and cortical perfusion in the etiology of MMD.
Insights
Blood-brain barrier (BBB) impairment is more significant in Moyamoya disease (MMD) patients than in atherosclerotic cerebrovascular disease (ACVD) patients. Superficial temporal artery-middle cerebral artery (STA-MCA) bypass improves cortical perfusion, especially in areas with BBB impairment.
Area of Science:
- Neurology
- Vascular Biology
- Neurosurgery
Background:
- Moyamoya disease (MMD) is increasingly linked to blood-brain barrier (BBB) dysfunction.
- In vivo studies on BBB impairment and cortical perfusion in MMD are scarce.
Purpose of the Study:
- To investigate in vivo BBB permeability and cortical perfusion in MMD patients.
- To evaluate the impact of superficial temporal artery-middle cerebral artery (STA-MCA) bypass on cortical perfusion in MMD and atherosclerotic cerebrovascular disease (ACVD) patients.
Main Methods:
- 16 MMD and 9 ACVD patients undergoing STA-MCA bypass were studied.
- Intraoperative indocyanine green (ICG) videoangiography assessed cortical perfusion (Blood Flow Index, BFI).
- Sodium fluorescein (NaFl) evaluated in vivo BBB permeability.
Main Results:
- MMD patients exhibited more significant BBB impairment than ACVD patients.
- Cortical perfusion (BFI) improved significantly post-STA-MCA bypass in both MMD and ACVD groups.
- Cortical perfusion was significantly lower in areas with BBB impairment compared to intact BBB areas.
- STA-MCA bypass significantly improved perfusion in BBB-impaired regions.
Conclusions:
- BBB impairment is more pronounced in MMD than ACVD.
- This study is the first to demonstrate reduced cortical perfusion in MMD patients with BBB impairment.
- STA-MCA bypass effectively enhances cortical perfusion in BBB-impaired areas, offering new insights into MMD etiology.
