PDF(Pubmed)
Abstract：
BACKGROUND: Local vasogenic edema induced after direct revascularization in moyamoya disease (MMD) is associated with blood-brain barrier dysfunction, potentially leading to postoperative cerebral hyperperfusion (CHP) or delayed intracerebral hemorrhage. This phenomenon allows the leakage of fluids, proteins, and other substances from the blood vessels into the extracellular compartment. Typically, such edema is observed postoperatively rather than intraoperatively.
METHODS: A 48-year-old female with ischemic-onset MMD underwent revascularization on her left hemisphere with Suzuki\'s angiographic stage III. Direct bypass was successfully performed, as confirmed by intravenous indocyanine green (ICG) video angiography. Subsequently, ICG extravasation was observed near the anastomosis site, despite the absence of cortical injury or bleeding under white light microscopy. Postoperative radiological imaging showed reversible pure vasogenic edema in the corresponding area, with no evidence of CHP. The patient did not exhibit neurological deterioration and was discharged home on postoperative day 16.
CONCLUSIONS: ICG, characterized by low molecular weight, water solubility, and high affinity with plasma proteins, can extravasate, serving as a direct indication of local vasogenic edema induced by direct revascularization in MMD. To enhance comprehension of the vulnerability of the blood-brain barrier in MMD, it is advisable to gather cases with prolonged observations of ICG video angiography after direct revascularization.
METHODS: A 48-year-old female with ischemic-onset MMD underwent revascularization on her left hemisphere with Suzuki\'s angiographic stage III. Direct bypass was successfully performed, as confirmed by intravenous indocyanine green (ICG) video angiography. Subsequently, ICG extravasation was observed near the anastomosis site, despite the absence of cortical injury or bleeding under white light microscopy. Postoperative radiological imaging showed reversible pure vasogenic edema in the corresponding area, with no evidence of CHP. The patient did not exhibit neurological deterioration and was discharged home on postoperative day 16.
CONCLUSIONS: ICG, characterized by low molecular weight, water solubility, and high affinity with plasma proteins, can extravasate, serving as a direct indication of local vasogenic edema induced by direct revascularization in MMD. To enhance comprehension of the vulnerability of the blood-brain barrier in MMD, it is advisable to gather cases with prolonged observations of ICG video angiography after direct revascularization.
摘要：
背景：烟雾病（MMD）直接血运重建后引起的局部血管源性水肿与血脑屏障功能障碍有关，可能导致术后脑过度灌注（CHP）或迟发性脑出血。这种现象允许液体泄漏，蛋白质，和其他物质从血管进入细胞外室。通常,这种水肿是在术后而不是术中观察到的。
方法：一名48岁女性缺血性发作性MMD患者在她的左半球接受了血管重建术，Suzuki的血管造影III期。已成功执行直接旁路,经静脉吲哚菁绿（ICG）视频血管造影证实。随后，在吻合部位附近观察到ICG外渗，尽管在白光显微镜下没有皮质损伤或出血。术后影像学显示相应区域可逆性单纯血管源性水肿，没有卫生防护中心的证据。患者未出现神经系统恶化，并在术后第16天出院。
结论：ICG，其特点是低分子量，水溶性，和血浆蛋白的高亲和力，可以外溢，作为MMD直接血运重建引起的局部血管源性水肿的直接指征。为了提高对MMD中血脑屏障脆弱性的认识，建议在直接血运重建后收集长期观察ICG视频血管造影的病例.
方法：一名48岁女性缺血性发作性MMD患者在她的左半球接受了血管重建术，Suzuki的血管造影III期。已成功执行直接旁路,经静脉吲哚菁绿（ICG）视频血管造影证实。随后，在吻合部位附近观察到ICG外渗，尽管在白光显微镜下没有皮质损伤或出血。术后影像学显示相应区域可逆性单纯血管源性水肿，没有卫生防护中心的证据。患者未出现神经系统恶化，并在术后第16天出院。
结论：ICG，其特点是低分子量，水溶性，和血浆蛋白的高亲和力，可以外溢，作为MMD直接血运重建引起的局部血管源性水肿的直接指征。为了提高对MMD中血脑屏障脆弱性的认识，建议在直接血运重建后收集长期观察ICG视频血管造影的病例.
