Characteristic Pattern of the Cerebral Hemodynamic Changes in the Acute Stage After Combined Revascularization Surgery for Adult Moyamoya Disease: N-isopropyl-p-[123I] iodoamphetamine Single-Photon Emission Computed Tomography Study

Miki Fujimura, Teiji Tominaga

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Objective: Surgical revascularization for moyamoya disease (MMD) prevents cerebral ischemic attack by improving cerebral blood flow (CBF) and could also reduce the risk of re-bleeding in hemorrhagic-onset patients. We sought to clarify the cerebral hemodynamic changes in the acute stage after revascularization surgery for adult MMD. Materials and methods: The present study includes 54 consecutive adult patients with MMD (21–76 years old, 43.1 average), undergoing superficial temporal artery-middle cerebral artery anastomosis with indirect pial synangiosis on 65 affected hemispheres. We prospectively performed single-photon emission computed tomography (SPECT) at postoperative day (POD) 1 and 7 of 65 surgeries. Perioperative management was conducted with strict blood pressure control (100–130 mmHg) and minocycline hydrochloride administration. Results: The outcome of 65 surgeries was favorable except for one (1.5%), which manifested as delayed intracerebral hemorrhage due to local hyperperfusion. The postoperative SPECT revealed the characteristic CBF improvement pattern with transient local hyperperfusion (POD1) and subsequent distribution of CBF in wider vascular territory (POD7) on 37 hemispheres (56.9%, 37/65). Conclusion: The revascularization surgery is a safe and effective treatment for adult MMD, while transient local hyperperfusion should be strictly managed by intensive perioperative care.

Original languageEnglish
Title of host publicationActa Neurochirurgica, Supplementum
PublisherSpringer Science and Business Media Deutschland GmbH
Pages57-61
Number of pages5
DOIs
Publication statusPublished - 2021

Publication series

NameActa Neurochirurgica, Supplementum
Volume132
ISSN (Print)0065-1419
ISSN (Electronic)2197-8395

Keywords

  • Extracranial-intracranial bypass
  • Hyperperfusion
  • Moyamoya disease
  • Single photon emission computed tomography

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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