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White and Gray Matter Perfusion in Children with Moyamoya Angiopathy after Revascularization Surgery
Elena Filimonova1,2, Azniv Martirosyan1, Konstantin Ovsiannikov1,3
1Federal Center of Neurosurgery Novosibirsk, Nemirovich-Danchenko Str. 132/1, Novosibirsk, Russian Federation.
Introduction:
Surgical revascularization is very effective in patients with moyamoya angiopathy (MMA) and leads to improvements in cortical perfusion parameters. However, changes in white matter hemodynamics are still underestimated. To date, only a few studies have examined brain perfusion changes within deep white matter after bypass surgery in patients with MMA.
Methods:
Ten children with MMA were evaluated using the CT perfusion technique before and after revascularization surgery. Brain perfusion parameters within gray and white matter were compared before and after surgery. The correlations between the perfusion parameters before surgery and the Suzuki stage, as well as between the perfusion parameters and the cognitive scores, were also evaluated.
Results:
Brain perfusion parameters improved significantly in both gray matter (predominantly due to cerebral blood flow within the anterior circulation, p < 0.01) and white matter (predominantly due to cerebral blood volume within the semiovale centrum, p < 0.001). We revealed that the pattern of improvement in perfusion in white matter differed from the pattern of improvement in perfusion in gray matter. Significant correlations were revealed between the Suzuki stage before surgery and the perfusion parameters within the posterior cerebral artery circulation (adjusted p < 0.05). There were also significant correlations between cognitive scores and brain perfusion parameters in gray matter and white matter (adjusted p < 0.05).
Conclusions:
The perfusion parameters of gray matter and white matter in the brain improve differently after bypass surgery in patients with MMA. Different hemodynamics within these compartments could explain this.
Insights
Bypass surgery significantly improves brain perfusion in both gray and white matter for moyamoya angiopathy (MMA) patients. However, white matter perfusion changes differ from gray matter, highlighting distinct hemodynamic responses post-revascularization.
Area of Science:
- Neuroscience
- Radiology
- Neurosurgery
Background:
- Moyamoya angiopathy (MMA) is a cerebrovascular disorder.
- Surgical revascularization effectively improves cortical perfusion in MMA patients.
- White matter hemodynamic changes after revascularization are understudied.
Purpose of the Study:
- To evaluate brain perfusion changes in gray and white matter after revascularization in pediatric MMA patients.
- To compare perfusion improvements between gray and white matter.
- To investigate correlations between pre-operative perfusion, Suzuki stage, and cognitive scores.
Main Methods:
- Ten pediatric MMA patients underwent CT perfusion imaging before and after revascularization.
- Brain perfusion parameters (cerebral blood flow and volume) were analyzed in gray and white matter.
- Statistical analyses assessed changes in perfusion and correlations with clinical factors.
Main Results:
- Significant improvements in gray matter (cerebral blood flow) and white matter (cerebral blood volume) perfusion were observed post-surgery.
- The patterns of perfusion improvement differed between gray and white matter.
- Correlations were found between pre-operative Suzuki stage, cognitive scores, and perfusion parameters in specific brain regions.
Conclusions:
- Gray and white matter perfusion parameters demonstrate distinct improvement patterns following bypass surgery in MMA.
- Divergent hemodynamics within these brain compartments may explain the observed differences.
- Revascularization impacts both cortical and deep white matter perfusion, with implications for cognitive function.
