Chronological Volume Changes of the Temporal Muscle Pedicle Used for Encephalo-myo-synangiosis in Combined Revascularization for Moyamoya Disease: A Prospective Observational Study
Although postoperative neurological events due to brain compression by the swollen temporal muscle are a rare complication, the chronological volume changes of the temporal muscle pedicle and their clinical impact have not yet been documented. This prospective observational study aimed to investigat...
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| Format: | Article |
| Language: | English |
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The Japan Neurosurgical Society
2023-07-01
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| Series: | Neurologia Medico-Chirurgica |
| Subjects: | |
| Online Access: | https://www.jstage.jst.go.jp/article/nmc/63/7/63_2023-0008/_pdf/-char/en |
| _version_ | 1827872182937583616 |
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| author | Makoto MIZUSHIMA Masaki ITO Noriyuki FUJIMA Haruto UCHINO Taku SUGIYAMA Miki FUJIMURA |
| author_facet | Makoto MIZUSHIMA Masaki ITO Noriyuki FUJIMA Haruto UCHINO Taku SUGIYAMA Miki FUJIMURA |
| author_sort | Makoto MIZUSHIMA |
| collection | DOAJ |
| description | Although postoperative neurological events due to brain compression by the swollen temporal muscle are a rare complication, the chronological volume changes of the temporal muscle pedicle and their clinical impact have not yet been documented. This prospective observational study aimed to investigate the chronological volume changes in the temporal muscle pedicle in Moyamoya disease (MMD). Eighteen consecutive combined revascularization procedures using the temporal muscle were performed for symptomatic MMD in 2021. The postoperative pedicle volume was quantified using repeated computed tomography images on postoperative days (PODs) 0, 1, 7, 14, and 30. Postoperative neurological events with radiological evaluations and collateral development evaluated using magnetic resonance angiography obtained 6 months after surgery were studied. On average, the postoperative temporal muscle pedicle volume was most significantly increased by as much as 112% ± 9.6% on POD 7 (P < 0.001) and decreased by as little as 52% ± 21% on POD 30 (P < 0.0001) relative to POD 0. One exceptional patient (overall incidence, 5.6%) demonstrated postoperative transient neurological events due to brain compression by the swollen temporal muscle with decreased focal cerebral blood flow in the adjacent cortical area. The postoperative collateral development via direct and indirect revascularizations was confirmed in 16 (89%) and 12 (67%) hemispheres, respectively. All patients, except for one rebleeding case, showed independent outcomes at the mean latest follow-up period on 290 ± 96 days after surgery. Our observations confirmed the temporal profile of muscle pedicle volume changes after combined revascularization. Through routine attempts to avoid the unfavorable effects of temporal muscle swelling, combined revascularization can provide favorable outcomes in symptomatic MMD. |
| first_indexed | 2024-03-12T16:19:40Z |
| format | Article |
| id | doaj.art-9f188d54bc0e4ddca05d2b4594c1ba35 |
| institution | Directory Open Access Journal |
| issn | 1349-8029 |
| language | English |
| last_indexed | 2024-03-12T16:19:40Z |
| publishDate | 2023-07-01 |
| publisher | The Japan Neurosurgical Society |
| record_format | Article |
| series | Neurologia Medico-Chirurgica |
| spelling | doaj.art-9f188d54bc0e4ddca05d2b4594c1ba352023-08-08T23:34:16ZengThe Japan Neurosurgical SocietyNeurologia Medico-Chirurgica1349-80292023-07-0163730431210.2176/jns-nmc.2023-00082023-0008Chronological Volume Changes of the Temporal Muscle Pedicle Used for Encephalo-myo-synangiosis in Combined Revascularization for Moyamoya Disease: A Prospective Observational StudyMakoto MIZUSHIMA0Masaki ITO1Noriyuki FUJIMA2Haruto UCHINO3Taku SUGIYAMA4Miki FUJIMURA5Department of Neurosurgery, Hokkaido University Graduate School of MedicineDepartment of Neurosurgery, Hokkaido University Graduate School of MedicineDepartment of Diagnostic and Interventional Radiology, Hokkaido University HospitalDepartment of Neurosurgery, Hokkaido University Graduate School of MedicineDepartment of Neurosurgery, Hokkaido University Graduate School of MedicineDepartment of Neurosurgery, Hokkaido University Graduate School of MedicineAlthough postoperative neurological events due to brain compression by the swollen temporal muscle are a rare complication, the chronological volume changes of the temporal muscle pedicle and their clinical impact have not yet been documented. This prospective observational study aimed to investigate the chronological volume changes in the temporal muscle pedicle in Moyamoya disease (MMD). Eighteen consecutive combined revascularization procedures using the temporal muscle were performed for symptomatic MMD in 2021. The postoperative pedicle volume was quantified using repeated computed tomography images on postoperative days (PODs) 0, 1, 7, 14, and 30. Postoperative neurological events with radiological evaluations and collateral development evaluated using magnetic resonance angiography obtained 6 months after surgery were studied. On average, the postoperative temporal muscle pedicle volume was most significantly increased by as much as 112% ± 9.6% on POD 7 (P < 0.001) and decreased by as little as 52% ± 21% on POD 30 (P < 0.0001) relative to POD 0. One exceptional patient (overall incidence, 5.6%) demonstrated postoperative transient neurological events due to brain compression by the swollen temporal muscle with decreased focal cerebral blood flow in the adjacent cortical area. The postoperative collateral development via direct and indirect revascularizations was confirmed in 16 (89%) and 12 (67%) hemispheres, respectively. All patients, except for one rebleeding case, showed independent outcomes at the mean latest follow-up period on 290 ± 96 days after surgery. Our observations confirmed the temporal profile of muscle pedicle volume changes after combined revascularization. Through routine attempts to avoid the unfavorable effects of temporal muscle swelling, combined revascularization can provide favorable outcomes in symptomatic MMD.https://www.jstage.jst.go.jp/article/nmc/63/7/63_2023-0008/_pdf/-char/enencephalo-myo-synangiosismoyamoya diseaseswollen temporal muscletime-coursevascular disorder |
| spellingShingle | Makoto MIZUSHIMA Masaki ITO Noriyuki FUJIMA Haruto UCHINO Taku SUGIYAMA Miki FUJIMURA Chronological Volume Changes of the Temporal Muscle Pedicle Used for Encephalo-myo-synangiosis in Combined Revascularization for Moyamoya Disease: A Prospective Observational Study Neurologia Medico-Chirurgica encephalo-myo-synangiosis moyamoya disease swollen temporal muscle time-course vascular disorder |
| title | Chronological Volume Changes of the Temporal Muscle Pedicle Used for Encephalo-myo-synangiosis in Combined Revascularization for Moyamoya Disease: A Prospective Observational Study |
| title_full | Chronological Volume Changes of the Temporal Muscle Pedicle Used for Encephalo-myo-synangiosis in Combined Revascularization for Moyamoya Disease: A Prospective Observational Study |
| title_fullStr | Chronological Volume Changes of the Temporal Muscle Pedicle Used for Encephalo-myo-synangiosis in Combined Revascularization for Moyamoya Disease: A Prospective Observational Study |
| title_full_unstemmed | Chronological Volume Changes of the Temporal Muscle Pedicle Used for Encephalo-myo-synangiosis in Combined Revascularization for Moyamoya Disease: A Prospective Observational Study |
| title_short | Chronological Volume Changes of the Temporal Muscle Pedicle Used for Encephalo-myo-synangiosis in Combined Revascularization for Moyamoya Disease: A Prospective Observational Study |
| title_sort | chronological volume changes of the temporal muscle pedicle used for encephalo myo synangiosis in combined revascularization for moyamoya disease a prospective observational study |
| topic | encephalo-myo-synangiosis moyamoya disease swollen temporal muscle time-course vascular disorder |
| url | https://www.jstage.jst.go.jp/article/nmc/63/7/63_2023-0008/_pdf/-char/en |
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