Clinical study on the ultrastructure of the middle cerebral artery in moyamoya disease using transmission electron microscopy
Objective To observe the ultrastructure of the middle cerebral artery(MCA)in patients with moyamoya disease(MMD)using Transmission electron microscopy,and to explore the differences in the ultrastructure of blood vessels of different types and different Suzuki stages of MMD.Methods The clinical data of 52 patients with MMD and their MCA specimens who were diagnosed and treated at the Neurosurgery Department of Henan Provincial People's Hospital from December 2021 to December 2022 were collected for retrospective research.Among them,there were 33 cases of ischemic MMD,6,7,18,and 2 cases of Suzuki stage Ⅱ,Ⅲ,Ⅳ,and Ⅴ respectively;19 cases of hemorrhagic MMD,and 1,4,10,4 cases of Suzuki stage Ⅱ,Ⅲ,Ⅳ,and Ⅴ respectively.The ultrastructure of the blood vessel wall was observed under a transmission electron microscope,and the degree of rupture of the internal elastic membrane under a 1 000 × electron microscope was scored(the higher the score,the more severe the rupture).Image J software was used to measure the area of endothelial cells under a 3 000 x electron microscope.We then compared the ultrastructural differences of MCA of different types and different Suzuki stages of MMD.Results With the progression of Suzuki stage,the degree of endothelial cell necrosis and exfoliation,the thinning and rupture of the internal elastic membrane of MCA intimal layer in hemorrhagic MMD showed a trend of aggravation,and smooth muscle migration was observed throughout the whole Suzuki stage.Additionally,there was an abundance of smooth muscle cells in the tunica media,a large number of fibroblasts in the tunica adventitia,and organelle dissipation in the tunica adventitia.Notably,there were no significant differences in the morphology of the nucleus or endoplasmic reticulum among different Suzuki stages.Conversely,the alterations in endothelial cells and the internal elastic membrane of the MCA in ischemic MMD did not manifest distinctly with the advancement of Suzuki stages,and smooth muscle cells migrated to the intima layer consistently across different Suzuki stages,with abundant presence in the media layer.Extensive fibroblast disintegration and organelle dispersion occurred in the adventitia layer.There was no significant difference in nuclear morphology or endoplasmic reticulum morphology among different Suzuki stages.The area of MCA endothelial cells[M(Q1,Q3)]in hemorrhagic MMD was 12.67(1.08,20.90)μm2,and 16.42(10.20,23.36)μm2 in ischemic MMD,the difference was statistically significant(P=0.045).The rupture degree of internal elastic membrane of MCA[M(Q1,Q3)]was 1(0,2)points in ischemic MMD,and 2(1,3)points in hemorrhagic MMD,and the difference was statistically significant(P=0.013).Conclusions There were differences in the ultrastructure of MCA in different Suzuki stages and different types of MMD.The degree of vascular ultrastructure damage had a tendency to aggravate with the progression of Suzuki stages,with hemorrhagic MMD exhibiting greater severity compared to the ischemic MMD.
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