Neuro-Chirurgie · 2026
Postoperative recruitment and remodeling of middle meningeal artery collaterals in adult moyamoya disease: implications for preservation during combined revascularization.
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Yang Xingzhi, Hu Miao, Tao Tianshu, Zhou Yinan, Zhang Jianjian
Аннотация
BACKGROUND: The middle meningeal artery (MMA) may provide pre-existing transdural flow and postoperative collateral recruitment in adult moyamoya disease (MMD). We evaluated MMA remodeling, recruitment, and the safety relevance of preserving visible branches during combined revascularization.
METHODS: This retrospective hemisphere-level study included 110 operated hemispheres from 85 adults undergoing superficial temporal artery-middle cerebral artery bypass with encephaloduromyosynangiosis. Preoperative angiography showed visible MMA collaterals in 38 hemispheres and none in 72. Outcomes included vessel diameters, MMA caliber change ratio (MMA-CCR), Matsushima grade, and perioperative infarction. Groups were further classified by intraoperative MMA preservation or injury and by postoperative recruitment.
RESULTS: Hemispheres with visible preoperative collaterals had more advanced Suzuki stages (P < 0.001), larger postoperative MMA diameters (P = 0.006), and smaller postoperative donor superficial temporal artery diameters (P < 0.001). Among collateral-absent hemispheres, 56/72 (77.8%) developed postoperative MMA collaterals. Recruited hemispheres had better Matsushima grades (P = 0.001), larger preoperative (3.05 ± 1.14 vs 2.23 ± 1.19 mm; P = 0.016) and postoperative MMA diameters (P < 0.001), and higher MMA-CCR values (P < 0.001). Perioperative infarction occurred in 3/10 hemispheres with MMA injury and 0/28 with preservation (P = 0.014); this three-event association was exploratory.
CONCLUSION: The MMA showed postoperative recruitment and caliber remodeling. Visible branches should be preserved when technically feasible, although the observed association between injury and infarction requires validation.
METHODS: This retrospective hemisphere-level study included 110 operated hemispheres from 85 adults undergoing superficial temporal artery-middle cerebral artery bypass with encephaloduromyosynangiosis. Preoperative angiography showed visible MMA collaterals in 38 hemispheres and none in 72. Outcomes included vessel diameters, MMA caliber change ratio (MMA-CCR), Matsushima grade, and perioperative infarction. Groups were further classified by intraoperative MMA preservation or injury and by postoperative recruitment.
RESULTS: Hemispheres with visible preoperative collaterals had more advanced Suzuki stages (P < 0.001), larger postoperative MMA diameters (P = 0.006), and smaller postoperative donor superficial temporal artery diameters (P < 0.001). Among collateral-absent hemispheres, 56/72 (77.8%) developed postoperative MMA collaterals. Recruited hemispheres had better Matsushima grades (P = 0.001), larger preoperative (3.05 ± 1.14 vs 2.23 ± 1.19 mm; P = 0.016) and postoperative MMA diameters (P < 0.001), and higher MMA-CCR values (P < 0.001). Perioperative infarction occurred in 3/10 hemispheres with MMA injury and 0/28 with preservation (P = 0.014); this three-event association was exploratory.
CONCLUSION: The MMA showed postoperative recruitment and caliber remodeling. Visible branches should be preserved when technically feasible, although the observed association between injury and infarction requires validation.