As far as we know, an angiographical early venous filling (deep and cortical), red cortical vein, intraarterial pressure and pre- and postoperative CBF values in Moyamoya disease are not reported. We discussed about these points respectively.
(1) Angiographical early venous filling
In Moyamoya disease it was thought that the blood circulation time in the brain was slow, therefore the veins of the brain appeared very late angiographically. But we observed this time in our Moyamoya cases the angiographical early venous filling of the internal cerebral vein, the basal vein of Rosenthal and the ascending cortical vein. In Moyamoya brain there must be some parts where the blood circulation time is rather fast.
(2) Red cortical vein On a cortical surface, we observed the increase in number of pial vessels and red cortical veins in which the arterial and venous blood flowed forming a laminar flow. These findings were thought to be characteristic in Moyamoya disease. As the mechanism of the red cortical vein, there might exist an arteriovenous shunt, be based on luxury perfusion in ischemic regions, or reduction of O2 consumption in Moyamoya brain.
(3) Intraarterial pressure
In Moyamoya disease the proximal stump pressure of the MCA was very low due to the stenosis or occlusion of the terminal portion of the internal carotid artery, and the distal stump pressure of the MCA was rather high that means the relative development of leptomeningeal anastomosis.
(4) CBF values
After the extra- and intracranial bypass surgery, the Mean rCBF and the gray matter flow (Fg) which were lower preoperatively became high, and the white matter flow (Fw) which was higher preoperatively became low. This postoperative decrease of the Fw might be parallel that the Moyamoya vessels were reduced in number angiographically after the bypass surgery. These findings might mean that the bypass surgery could be a treatment not only for cerebral ischemia but also for intracranial bleeding in Moyamoya disease.
