Lessons Learned from the Initial Experience with Pedicled Temporoparietal Fascial Flap for Combined Revascularization In Moyamoya Angiopathy: A Case Series

被引:3
作者
Ravina, Kristine [1 ]
Kim, Paul E. [2 ]
Rennert, Robert C. [5 ]
Wolfswinkel, Erik M. [4 ]
Strickland, Ben A. [3 ]
Carey, Joseph N. [4 ]
Russin, Jonathan J. [1 ,3 ]
机构
[1] Univ Southern Calif, Keck Sch Med, Neurorestorat Ctr, Los Angeles, CA 90007 USA
[2] Univ Southern Calif, Keck Sch Med, Dept Radiol, Los Angeles, CA 90007 USA
[3] Univ Southern Calif, Keck Sch Med, Dept Neurol Surg, Los Angeles, CA 90007 USA
[4] Univ Southern Calif, Keck Sch Med, Dept Surg, Div Plast & Reconstruct Surg, Los Angeles, CA 90007 USA
[5] Univ Calif San Diego, Dept Neurosurg, San Diego, CA 92103 USA
关键词
Cerebral revascularization; Combined bypass; Moyamoya angiopathy; Temporoparietal pedicled flap; INDIRECT BYPASS; SURGICAL-TREATMENT; CLINICAL-FEATURES; DISEASE; COMPLICATIONS; ADULTS;
D O I
10.1016/j.wneu.2019.08.182
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: The pedicled temporoparietal fascial flap (TPFF) with a direct superficial temporal (STA) artery to middle cerebral artery (MCA) bypass is a novel combined revascularization approach for moyamoya angiopathy (MMA). With this case series, we aim to report the initial experience with pedicled TPFF combined revascularization for MMA treatment. METHODS: Data from 14 consecutive patients undergoing pedicled TPFF combined revascularization for MMA between May 2016 and December 2018 were retrospectively reviewed. Patients admitted with acute ischemia or a modified Rankin Scale (mRS) score >3 were considered high risk. RESULTS: Mean +/- standard deviation age on surgery was 41.9 +/- 15.4 years. Three of 14 patients (21.4%) presented with an mRS score >3. Nine of 14 patients (64.3%) presented with ischemic stroke, 4 of whom (44.4%) had acute ischemia. Direct anastomosis patency was confirmed in all cases postoperatively. Mean hospitalization time was 13 +/- 9.3 days and mean follow-up time was 14.1 +/- 9.3 months. From admission to follow-up, neurologic status improved in 8 patients (57.1%) and stabilized in 6 patients (42.9%). Overall, 11/14 patients (78.6%) achieved good functional outcome (mRS score <= 2). All patients achieved some radiographic collateral development, with 5 (71.5%) graded as Matsushima A and B. Three patients developed new radiographic ischemia and 3 experienced wound complications, all in the high-risk group. CONCLUSIONS: The TPFF combined approach is a viable strategy for revascularization in MMA. This technique may be suboptimal in patients presenting with acute ischemia and/or mRS score >3.
引用
收藏
页码:E259 / E273
页数:15
相关论文
共 34 条
[1]   Wound healing complications after revascularization for moyamoya vasculopathy with reference to different skin incisions [J].
Acker, Gueliz ;
Schlinkmann, Nicolas ;
Fekonja, Lucius ;
Gruenwald, Lukas ;
Hardt, Juliane ;
Czabanka, Marcus ;
Vajkoczy, Peter .
NEUROSURGICAL FOCUS, 2019, 46 (02)
[2]   Surgical Management of Moyamoya Disease [J].
Acker, Gueliz ;
Fekonja, Lucius ;
Vajkoczy, Peter .
STROKE, 2018, 49 (02) :476-482
[3]   Combined Direct and Indirect Bypass for Moyamoya: Quantitative Assessment of Direct Bypass Flow Over Time [J].
Amin-Hanjani, Sepideh ;
Singh, Amritha ;
Rifai, Hashem ;
Thulborn, Keith R. ;
Alaraj, Ali ;
Aletich, Victor ;
Charbel, Fady T. .
NEUROSURGERY, 2013, 73 (06) :962-967
[4]   Quantitative Angiographic Comparison With the OSIRIS Program Between the Direct and Indirect Revascularization Modalities in Adult Moyamoya Disease [J].
Bang, Jae Seung ;
Kwon, O-Ki ;
Kim, Jeong Eun ;
Kang, Hyun-Seung ;
Park, Hyun ;
Cho, Sung Yun ;
Oh, Chang Wan .
NEUROSURGERY, 2012, 70 (03) :625-633
[5]   Clinical Features, Surgical Treatment, and Long-Term Outcome in Pediatric Patients with Moyamoya Disease in China [J].
Bao, Xiang-Yang ;
Duan, Lian ;
Yang, Wei-Zhong ;
Li, De-Sheng ;
Sun, Wei-Jian ;
Zhang, Zheng-Shan ;
Zong, Rui ;
Han, Cong .
CEREBROVASCULAR DISEASES, 2015, 39 (02) :75-81
[6]  
Choi In Jae, 2012, J Cerebrovasc Endovasc Neurosurg, V14, P216, DOI 10.7461/jcen.2012.14.3.216
[7]   Improving Indirect Revascularization for Effective Treatment of Adult Moyamoya Disease: A Prospective Clinical, Cerebral Angiographic, and Perfusion Study [J].
Chou, Sheng-Che ;
Chen, Ya-Fang ;
Lee, Chung-Wei ;
Hsu, Hao-Chun ;
Wang, Kuo-Chuan ;
Yang, Shih-Hung ;
Liu, Hon-Man ;
Kuo, Meng-Fai .
WORLD NEUROSURGERY, 2018, 119 :E180-E191
[8]   Fundamental Basis of Scalp Layering Techniques to Protect Against Wound Infection: A Comparative Study Between Conventional and In-to-Out Dissection of the Superficial Temporal Artery [J].
Chung, Yeongu ;
Lee, Sung Ho ;
Choi, Seok Keun .
WORLD NEUROSURGERY, 2017, 97 :304-311
[9]  
DAVID SK, 1995, ARCH OTOLARYNGOL, V121, P1153
[10]   The Versatile Use of Temporoparietal Fascial Flap [J].
Demirdover, Cenk ;
Sahin, Baris ;
Vayvada, Haluk ;
Oztan, Hasan Yucel .
INTERNATIONAL JOURNAL OF MEDICAL SCIENCES, 2011, 8 (05) :362-368