Flow volume mismatch dramatically affects transient neurologic symptoms after direct bypass in Moyamoya disease.

Transient neurological events (TNEs) occur after bypass surgery in Moyamoya disease (MMD); however, their pathology remains unknown. To elucidate the pathophysiology of TNEs, we investigated their relationship with perioperative superficial temporal artery (STA) blood flow volume, which was evaluated using ultrasonography. Forty-nine patients with MMD, who underwent direct bypass surgery, were included and stratified into TNE and non-TNE groups, respectively. The STA blood flow volume was evaluated at four time points (preoperatively and 2-4, 7, and 10-14 days postoperatively), and a change in volume during the postoperative period was defined as a flow volume mismatch. We investigated the association between ultrasonographic findings of flow volume mismatch and TNEs and magnetic resonance imaging findings, such as the cortical hyperintensity belt (CHB) sign, using univariate and path analyses. The STA blood flow volume increased immediately postoperatively, gradually decreasing over time, in both groups. The TNE group showed a significant increase in blood flow volume 2-4 days postoperatively (P = 0.042). Flow volume mismatch was significantly larger in the TNE group than in the non-TNE group (P = 0.020). In the path analysis, STA flow volume mismatch showed a positive association with the CHB sign (P = 0.023) and TNEs (P = 0.000). Additionally, the CHB sign partially mediated the association between STA flow volume mismatch and TNEs. These results suggest that significantly high STA blood flow volume changes occurring during the acute postoperative period after direct bypass surgery in MMD are correlated with TNEs and the CHB sign, suggesting involvement in the pathophysiology of TNEs.

Relevance of the Foramen of Vesalius for Preoperative Tumor Embolization in Skull Base Meningioma.

OBJECTIVE: The objective of this study was to investigate the role of the foramen of Vesalius (FV) in the pathogenesis of skull base meningioma by analyzing data from various multi-image modalities. METHODS: For this single-center retrospective study, 39 consecutive patients with skull base meningioma who underwent tumor resection between January 2020 and March 2023 were enrolled. The anatomical and pathological characteristics of the FV were evaluated using computed tomography and 3-dimensional digital subtraction angiography. The clinical significance of the FV in tumor hemodynamics and treatment, such as preoperative tumor embolization, was investigated using the 3-dimensional digital subtraction angiography/computed tomography fusion images. RESULTS: We identified FV in 52% (17/27) of the finally included patients. In 10 (30%) patients, the FV was found bilaterally with no significant variation in appearance between the healthy and tumor-affected sides (P = 0.786). The mean FV diameter was significantly larger on the tumor-affected side (P = 0.010). No significant anatomical differences, like duplication and partial assimilation with the foramen ovale, were observed between the 2 sides. The FV was involved in venous skull base perfusion around the tumor in 9 cases. In 4 cases where it was the pathway for tumor feeders, preoperative tumor embolization via the FV resulted in disappearance of the tumor stain. No complications associated with endovascular treatment were observed. CONCLUSIONS: This study elucidated the anatomical asymmetry of the FV and its role in the hemodynamics of skull base meningioma. Our findings highlight the significance of performing anatomical and pathological evaluations of the FV in determining treatment strategies, including preoperative embolization, for skull base lesions.

Molecular Identification and Pathogenicity of Novel Duck-Origin Goose Parvovirus Isolated from Beak Atrophy and Dwarfism Syndrome of Waterfowls in the North of Vietnam.

The aim of this study is to identify and characterize virus isolates (which are named for Bacgiang Agriculture and Forestry University [BAFU]) from diseased Cherry Valley duck and mule duck flocks and investigate the damage caused by a novel parvovirus-related virus (DuPV) to tissues and organs, including the brain, cerebellum, kidney, liver, lung, spleen, and spinal cord. The results of phylogenetic analysis show that DuPV-BAFU evolved from a goose lineage and duck parvoviruses rather than from Muscovy duck parvoviruses. In the genetic lineages, DuPVs were identified from the DuPV samples analyzed, and DuPV-BAFU was found to be closely clustered with two known goose origin parvoviruses (GPVa2006 and GPV1995) and a duck GPVs. Finally, structural modeling revealed that DuPV-BAFU and the closely related viruses GPVa2006 and GPV1995 possessed identical clusters of receptor-interacting amino acid residues in the VP3 protein, a major determinant of viral receptor binding and host specificity. Significantly, these three viruses differed from DuPVs, Muscovy duck parvoviruses, and other goose parvoviruses at these positions. These results also demonstrated that DuPV-BAFU represents a new variant of goose-origin parvovirus that currently circulates in ducklings and causes beak atrophy and dwarfism syndrome, as noted in the previous reports in Europe, Taiwan, and China. This new finding highlights the need for future surveillance of DuPV-BAFU in waterfowl in order to gain a better understanding of both the evolution and the biology of this emerging parvovirus in waterfowl.

Identificación molecular y patogenicidad de un nuevo parvovirus de ganso de origen en pato aislado del síndrome de atrofia del pico y enanismo de las aves acuáticas en el norte de Vietnam. El objetivo de este estudio es identificar y caracterizar aislados de virus detectados en la Universidad de Agricultura y Silvicultura de Bacgiang (BAFU) de parvadas de patos enfermos Cherry Valley e híbridos y también investigar el daño causado por un nuevo virus relacionado con parvovirus del pato (DuPV) en tejidos y órganos, incluidos el cerebro, el cerebelo, los riñones, el hígado, los pulmones, el bazo y la médula espinal. Los resultados del análisis filogenético mostraron que el virus DuPV-BAFU evolucionó a partir de un linaje de parvovirus de patos y gansos en lugar del parvovirus de patos reales. En los linajes genéticos, se identificaron virus DuPV a partir de las muestras de DuPV analizadas, y se encontró que el DuPV-BAFU estaba estrechamente agrupado con dos parvovirus conocidos de origen de ganso (GPVa2006 y GPV1995) y con parvovirus de pato. Finalmente, el modelado estructural reveló que el virus DuPV-BAFU y los virus estrechamente relacionados GPVa2006 y GPV1995 poseían grupos idénticos de residuos de aminoácidos que interactúan con el receptor en la proteína VP3, que es un determinante importante de la unión al receptor viral y la especificidad del huésped. Significativamente, estos tres virus diferían de los DuPV, los parvovirus del pato real y de otros parvovirus del ganso en estas posiciones. Estos resultados también demostraron que el virus DuPV-BAFU representa una nueva variante del parvovirus de origen ganso que actualmente circula en patitos y causa atrofia del pico y síndrome de enanismo, como se señaló en reportes anteriores en Europa, Taiwán y China. Este nuevo hallazgo destaca la necesidad de una vigilancia futura para el virus DuPV-BAFU en las aves acuáticas para comprender mejor tanto la evolución como la biología de este parvovirus emergente en las aves acuáticas.