Superficial temporal artery to middle cerebral artery bypass for moyamoya disease complications

Superficial temporal artery to middle cerebral artery bypass for moyamoya disease complications

see Superficial temporal artery to middle cerebral artery bypass complications.

The Japan Adult Moyamoya study reported 1) 9.4% of complications in 84 cases reported.


Cerebral hyperperfusion syndrome (CHS) is a common complication after direct bypass surgery in patients with Moyamoya disease (MMD).

Although the main potential complications associated with this treatment are cerebral hyperperfusion and cerebral ischemia, the adverse impacts of revascularization surgery remain unclear.

Transient neurological symptoms are frequently observed during the early postoperative period after direct bypass surgery for moyamoya disease.

Hyperperfusion syndrome is believed to be the cause.


Abnormal signal changes in the cerebral cortex can be seen in postoperative MR images.

MR perfusion and Single photon emission computed tomography (SPECT) are well known imaging studies to evaluate hemodynamic change between prior to and following superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis in moyamoya disease. But their side effects and invasiveness make discomfort to patients.


Since preventive measures may be inadequate, Yang et al. assessed whether the blood flow difference between the superficial temporal artery (STA) and recipient vessels (△BF) and the direct perfusion range (DPR) are related to CHS.

They measured blood flow in the STA and recipient blood vessels before bypass surgery by transit-time probe to calculate △BF. Perfusion changes around the anastomosis before and after bypass were analyzed with FLOW 800 to obtain DPR. Multiple factors, such as △BF, DPR, and postoperative CHS, were analyzed using binary logistic regression.

Results: Forty-one patients with MMD who underwent direct bypass surgery were included in the study. Postoperative CHS symptoms occurred in 13/41 patients. △BF and DPR significantly differed between the CHS and non-CHS groups. The optimal receiver operating characteristic (ROC) curve cut-off value was 31.4 ml/min for ΔBF, and the area under the ROC curve (AUC) was 0.695 (sensitivity 0.846, specificity 0.500). The optimal cut-off value was 3.5 cm for DPR, and the AUC was 0.702 (sensitivity 0.615, specificity 0.750).

Postoperative CHS is caused by multiple factors. △BF is a risk factor for CHS while DPR is a protective factor against CHS 2).

References

1)

Miyamoto S, Yoshimoto T, Hashimoto N, Okada Y, Tsuji I, Tominaga T, Nakagawara J, Takahashi JC; JAM Trial Investigators. Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial. Stroke. 2014 May;45(5):1415-21. doi: 10.1161/STROKEAHA.113.004386. Epub 2014 Mar 25. PMID: 24668203.
2)

Yang D, Zhang X, Tan C, Han Z, Su Y, Duan R, Shi G, Shao J, Cao P, He S, Wang R. Intraoperative transit-time ultrasonography combined with FLOW800 predicts the occurrence of cerebral hyperperfusion syndrome after direct revascularization of Moyamoya disease: a preliminary study. Acta Neurochir (Wien). 2020 Oct 2. doi: 10.1007/s00701-020-04599-w. Epub ahead of print. PMID: 33006072.

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