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Efficacy assessment of superficial temporal artery–middle cerebral artery bypass surgery in treating moyamoya disease from a hemodynamic perspective: a pilot study using computational modeling and perfusion imaging

  • Original Article - Vascular Neurosurgery - Ischemia
  • Published:
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Abstract

Background

Superficial temporal artery–middle cerebral artery (STA–MCA) bypass is a common surgery in treating moyamoya disease (MMD) with occluded MCA. Computational fluid dynamics (CFD) simulation might provide a simple, non-invasive, and low-cost tool to evaluate the efficacy of STA–MCA surgery.

Aim

We aim to quantitatively investigate the treatment efficacy of STA–MCA surgery in improving the blood flow of MMD patients using CFD simulation.

Methods

This retrospective study included 11 MMD patients with occlusion around proximal MCA who underwent STA–MCA bypass surgery. CFD simulation was performed using patient-specific blood pressure and postoperative artery geometry. The volumetric flow rates of STA and the bypass, average flow velocity in the proximal segment of transcranial bypass, transcranial pressure drop, and transcranial flow resistance were measured and compared with a postoperative increment of cerebral blood flow (CBF) in MCA territories derived from perfusion imaging. Per-branch pressure drop from model inlet to bypass branch outlet was calculated.

Results

The volumetric flow rates of STA and the bypass were 80.84 ± 14.54 mL/min and 46.03 ± 4.21 mL/min. Average flow velocity in proximal bypass, transcranial pressure drop, and transcranial flow resistance were 0.19 ± 0.07 m/s, 3.72 ± 3.10 mmHg, and 6.54 ± 5.65 10−8 Pa s m−3. Postoperative mean increment of CBF in MCA territories was 16.03 ± 11.72 mL·100 g−1·min−1. Per-branch pressure drop was 10.96 ± 5.59 mmHg and 7.26 ± 4.25 mmHg in branches with and without stenosis.

Conclusions

CFD simulation results are consistent with CBF observation in verifying the efficacy of STA–MCA bypass, where postoperative stenosis may influence the hemodynamics.

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Data Availability

Data availability is restricted due to their sensitive nature. Anonymized data are available on reasonable request.

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Acknowledgements

We would like to acknowledge Dr. Syed Aziz Shah from Coventry University, UK, for his valuable advice in scientific writing.

Funding

This research was funded by the National Key Research and Development Program of China (Grant No. 2018YFE0198400).

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Author notes

  1. **nhong Wang and Haipeng Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang Province, China

    **nhong Wang, Mengxi Xu, Cong Chen & Linlin Ma

  2. Research Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK

    Haipeng Liu

  3. Department of Neurology, Zhoushan Hospital, Wenzhou Medical University, Zhoushan, 316000, Zhejiang Province, China

    Fangyu Dai

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  1. **nhong Wang
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Corresponding authors

Correspondence to **nhong Wang or Haipeng Liu.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the ethics committee of The Second Affiliated Hospital, Zhejiang University School of Medicine (Date 20 August 2020/ No.12020001732).

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Wang, X., Liu, H., Xu, M. et al. Efficacy assessment of superficial temporal artery–middle cerebral artery bypass surgery in treating moyamoya disease from a hemodynamic perspective: a pilot study using computational modeling and perfusion imaging. Acta Neurochir 165, 613–623 (2023). https://doi.org/10.1007/s00701-022-05455-9

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