Login Register Cart 0
Generic placeholder image

Current Neurovascular Research

Editor-in-Chief

ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Risk Factors for Cerebral Hyperperfusion Syndrome After Combined Revascularization in Adult Patients with Moyamoya Disease

Author(s): Dongxiao Xu, Jiaojiao Guo, Bingjie Zheng, Qiaowei Wu, Ilgiz Gareev, Ozal Beylerli, Aferin Beilerli and Huaizhang Shi*

Volume 20, Issue 5, 2023

Published on: 06 February, 2024

Page: [623 - 629] Pages: 7

DOI: 10.2174/0115672026287201240110092653

Price: $65

Abstract

Background: Cerebral hyperperfusion syndrome (CHS) is known as a complication after bypass surgery for Moyamoya disease (MMD). However, the incidence of CHS has not been accurately reported, and there is no consensus on the risk factors associated with it.

Aim: The aim of this study was to determine the risk factors associated with postoperative CHS after surgical combined revascularization used to treat adult patients with MMD.

Objective: To assess the frequency and characteristics of CHS in patients with MMD after revascularization operations.

Methods: Patients who received combined revascularization from Jan 2021 to Nov 2022 were retrospectively reviewed. Preoperative clinical characteristics and radiographic features were recorded. Postoperative CHS after surgery were examined. Multivariate logistic regression analyses were performed to identify the risk factors for CHS.

Results: A total of 133 patients (141 hemispheres) were included in this study. Postoperative CHS were observed in 28 hemispheres (19.8%), including focal cerebral hyperperfusion syndrome (FCHS) in 20 hemispheres (14.2%), hemorrhage in 4 (2.8%) hemispheres, seizures in 4 (2.8%) hemispheres. The results of multivariate logistic regression analysis indicated that preoperative hypertension (OR 4.705, 95% CI 1.323 ~ 12.554, p = 0.014), cerebral hemorrhage onset (OR 5.390, 95% CI 1.408 ~ 20.642, p = 0.014) and higher Hct level (OR 1.171, 95% CI 1.051 ~ 1.305, p = 0.004) were significantly associated with CHS after combined revascularization.

Conclusions: Preoperative hypertension, cerebral hemorrhage onset, and higher Hct level were independent risk factors for CHS after combined revascularization.

« Previous
[1]
Kuroda S, Fujimura M, Takahashi J, et al. (Spontaneous occlusion of circle of willis) of the ministry of health, labor, and welfare, japan. diagnostic criteria for moyamoya disease - 2021 revised version. Neurol Med Chir 2022; 62(7): 307-12.
[http://dx.doi.org/10.2176/jns-nmc.2022-0072] [PMID: 35613882]
[2]
Zhao Y, Yu S, Lu J, et al. Direct bypass surgery vs. combined bypass surgery for hemorrhagic moyamoya disease: A comparison of angiographic outcomes. Front Neurol 2018; 9: 1121.
[http://dx.doi.org/10.3389/fneur.2018.01121] [PMID: 30619072]
[3]
Choi IJ, Cho SJ, Chang JC, Park SQ, Park HK. Angiographic results of indirect and combined bypass surgery for adult moyamoya disease. J Cerebrovasc Endovasc Neurosurg 2012; 14(3): 216-22.
[http://dx.doi.org/10.7461/jcen.2012.14.3.216] [PMID: 23210050]
[4]
Kim T, Oh CW, Bang JS, Kim JE, Cho WS. Moyamoya disease: Treatment and outcomes. J Stroke 2016; 18(1): 21-30.
[http://dx.doi.org/10.5853/jos.2015.01739] [PMID: 26846757]
[5]
Acker G, Fekonja L, Vajkoczy P. Surgical management of moyamoya disease. Stroke 2018; 49(2): 476-82.
[http://dx.doi.org/10.1161/STROKEAHA.117.018563] [PMID: 29343587]
[6]
Zhao J, Liu H, Zou Y, Zhang W, He S. Clinical and angiographic outcomes after combined direct and indirect bypass in adult patients with moyamoya disease: A retrospective study of 76 procedures. Exp Ther Med 2018; 15(4): 3570-6.
[http://dx.doi.org/10.3892/etm.2018.5850] [PMID: 29545885]
[7]
Katsuki M, Fujimura M, Tashiro R, Tomata Y, Nishizawa T, Tominaga T. Pre-operative higher hematocrit and lower total protein levels are independent risk factors for cerebral hyperperfusion syndrome after superficial temporal artery–middle cerebral artery anastomosis with pial synangiosis in adult moyamoya disease patients-case-control study. Neurosurg Rev 2021; 44(4): 2191-200.
[http://dx.doi.org/10.1007/s10143-020-01395-z] [PMID: 32968846]
[8]
Manaka S, Ishijima B, Mayanagi Y. Postoperative seizures: Epidemiology, pathology, and prophylaxis. Neurol Med Chir 2003; 43(12): 589-600.
[http://dx.doi.org/10.2176/nmc.43.589] [PMID: 14723265]
[9]
van Mook WNKA, Rennenberg RJMW, Schurink GW, et al. Cerebral hyperperfusion syndrome. Lancet Neurol 2005; 4(12): 877-88.
[http://dx.doi.org/10.1016/S1474-4422(05)70251-9] [PMID: 16297845]
[10]
Xu D, Zheng B, Wu Q, et al. Outcomes after superficial temporal artery-middle cerebral artery anastomosis combined with multiple burr hole surgery and dural inversion synangiosis for Moyamoya disease in adults. Front Surg 2022; 4(9): 1047727.
[11]
Chui J, Manninen P, Sacho RH, Venkatraghavan L. Anesthetic management of patients undergoing intracranial bypass procedures. Anesth Analg 2015; 120(1): 193-203.
[http://dx.doi.org/10.1213/ANE.0000000000000470] [PMID: 25625262]
[12]
Fujimura M, Mugikura S, Kaneta T, Shimizu H, Tominaga T. Incidence and risk factors for symptomatic cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with moyamoya disease. Surg Neurol 2009; 71(4): 442-7.
[http://dx.doi.org/10.1016/j.surneu.2008.02.031] [PMID: 18514264]
[13]
Fujimura M, Shimizu H, Inoue T, Mugikura S, Saito A, Tominaga T. Significance of focal cerebral hyperperfusion as a cause of transient neurologic deterioration after extracranial-intracranial bypass for moyamoya disease: comparative study with non-moyamoya patients using N-isopropyl-p-[(123)I]iodoamphetamine single-photon emission computed tomography. Neurosurgery 2011; 68(4): 957-65.
[http://dx.doi.org/10.1227/NEU.0b013e318208f1da] [PMID: 21221039]
[14]
Fujimura M, Tominaga T. Lessons learned from moyamoya disease: Outcome of direct/indirect revascularization surgery for 150 affected hemispheres. Neurol Med Chir 2012; 52(5): 327-32.
[http://dx.doi.org/10.2176/nmc.52.327] [PMID: 22688070]
[15]
Uchino H, Kuroda S, Hirata K, Shiga T, Houkin K, Tamaki N. Predictors and clinical features of postoperative hyperperfusion after surgical revascularization for moyamoya disease: A serial single photon emission CT/positron emission tomography study. Stroke 2012; 43(10): 2610-6.
[http://dx.doi.org/10.1161/STROKEAHA.112.654723] [PMID: 22871684]
[16]
Finelli PF, Carley MD. Cerebral venous thrombosis associated with epoetin alfa therapy. Arch Neurol 2000; 57(2): 260-2.
[http://dx.doi.org/10.1001/archneur.57.2.260] [PMID: 10681086]
[17]
MacHida T, Ono J, Nomura R, Fujikawa A, Nagano O, Higuchi Y. Venous reddening as a possible sign of hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis for moyamoya disease: Case report. Neurol Med Chir 2014; 54(10): 827-31.
[http://dx.doi.org/10.2176/nmc.cr.2013-0261] [PMID: 24670309]
[18]
Fujimura M, Mugikura S, Shimizu H, Tominaga T. Diagnostic value of perfusion-weighted MRI for evaluating postoperative alteration of cerebral hemodynamics following STA-MCA anastomosis in patients with moyamoya disease. No Shinkei Geka 2006; 34(8): 801-9.
[PMID: 16910493]
[19]
Fujimura M, Inoue T, Shimizu H, Saito A, Mugikura S, Tominaga T. Efficacy of prophylactic blood pressure lowering according to a standardized postoperative management protocol to prevent symptomatic cerebral hyperperfusion after direct revascularization surgery for moyamoya disease. Cerebrovasc Dis 2012; 33(5): 436-45.
[http://dx.doi.org/10.1159/000336765] [PMID: 22456617]
[20]
Hill AB. The environment and disease: Association or causation? Proc R Soc Med 1965; 58(5): 295-300.
[http://dx.doi.org/10.1177/003591576505800503] [PMID: 14283879]
[21]
Lai PMR, Patel NJ, Frerichs KU, et al. Direct vs indirect revascularization in a north american cohort of Moyamoya disease. Neurosurgery 2021; 89(2): 315-22.
[http://dx.doi.org/10.1093/neuros/nyab156] [PMID: 33957674]
[22]
Chen Y, Ma L, Lu J, et al. Postoperative hemorrhage during the acute phase after direct or combined revascularization for moyamoya disease: Risk factors, prognosis, and literature review. J Neurosurg 2019; 18: 1-10.
[PMID: 31628285]
[23]
Uchino H, Yamamoto S, Kashiwazaki D, et al. Using postoperative remodeling of donor arteries on MR angiography to predict the development of surgical collaterals in Moyamoya disease. J Neurosurg 2019; 8: 1-9.
[http://dx.doi.org/10.3171/2019.8.JNS191846] [PMID: 31703196]
[24]
Funaki T, Takahashi JC, Houkin K, et al. High rebleeding risk associated with choroidal collateral vessels in hemorrhagic moyamoya disease: analysis of a nonsurgical cohort in the Japan Adult Moyamoya Trial. J Neurosurg 2019; 130(2): 525-30.
[http://dx.doi.org/10.3171/2017.9.JNS17576] [PMID: 29498573]
[25]
Funaki T, Takahashi JC, Yoshida K, et al. Periventricular anastomosis in moyamoya disease: Detecting fragile collateral vessels with MR angiography. J Neurosurg 2016; 124(6): 1766-72.
[http://dx.doi.org/10.3171/2015.6.JNS15845] [PMID: 26613176]
[26]
Liu P, Lv X, Liu A, et al. Intracranial aneurysms associated with moyamoya disease in children: clinical features and long-term surgical outcome. World Neurosurg 2016; 94: 513-20.
[http://dx.doi.org/10.1016/j.wneu.2016.05.039] [PMID: 27237414]
[27]
Fujimura M, Tominaga T. Significance of cerebral blood flow analysis in the acute stage after revascularization surgery for moyamoya disease. Neurol Med Chir 2015; 55(10): 775-81.
[http://dx.doi.org/10.2176/nmc.ra.2015-0063] [PMID: 26369873]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy