Document Detail

Experimental investigation of encephalomyosynangiosis using gyrencephalic brain of the miniature pig: histopathological evaluation of dynamic reconstruction of vessels for functional anastomosis. Laboratory investigation.
MedLine Citation:
PMID:  19485733     Owner:  NLM     Status:  MEDLINE    
OBJECT: Encephalomyosynangiosis (EMS) is a surgical treatment for moyamoya disease that is widely used to provide increased intracranial blood flow via revascularization by arterial anastomosis from the external carotid artery. However, the angiogenic mechanism responsible for the revascularization induced by EMS has not been systematically evaluated. In this study the authors investigated the chronological angiogenic changes associated with EMS to clarify the favorable factors and identify revascularization mechanisms by using an experimental internal carotid artery occlusion (ICAO) model in the miniature pig. METHODS: Fourteen miniature pigs were used, 11 of which underwent ICAO before transcranial surgery for EMS was performed. Animals were allowed to recover for 1 week (4 pigs) or 4 weeks (7 pigs) after EMS. Control group animals were treated in the same way, but without occlusion (3 pigs). Magnetic resonance imaging, angiography, and histological investigation were performed. RESULTS: One week after EMS, on histological examination of both the ICAO and control groups it was found that the transplanted temporal muscle had adhered to the arachnoid via a granulation zone, which was enriched with immune cells such as macrophages associated with the angiogenic process. Four weeks after EMS, angiography and histological examination of the ICAO group showed patent anastomoses between the external carotid artery and the cortical arteries without any detectable boundary between the temporal muscle and the cerebral cortex. In contrast, histological examination of the control group found scar tissue between the cerebral cortex and temporal muscle. CONCLUSIONS: The initial step for formation of anastomoses resembles the process of wound healing associated with repair processes such as active proliferation of macrophages and angiogenesis within the new connective tissue. Functional revascularization requires a suitable environment (such as tissue containing vascular beds) and stimulus (such as ischemia) to induce vascular expansion.
Mitsunobu Nakamura; Hideaki Imai; Kenjiro Konno; Chisato Kubota; Koji Seki; Sandra Puentes; Ahmad Faried; Hideaki Yokoo; Hidekazu Hata; Yuhei Yoshimoto; Nobuhito Saito
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurosurgery. Pediatrics     Volume:  3     ISSN:  1933-0707     ISO Abbreviation:  -     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-02     Completed Date:  2009-07-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101463759     Medline TA:  J Neurosurg Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  488-95     Citation Subset:  IM    
Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Japan.
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MeSH Terms
Anastomosis, Surgical
Carotid Artery Diseases / surgery
Cerebral Angiography
Cerebral Cortex / blood supply
Cerebral Revascularization / methods*
Magnetic Resonance Imaging
Moyamoya Disease / surgery*
Neovascularization, Physiologic / physiology
Swine, Miniature
Temporal Muscle / blood supply
Wound Healing

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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