Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF), and superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis and/or indirect pial synangiosis such as encephalo-myo-synangiosis (EMS) are generally accepted as the optimal surgical treatment for moyamoya disease [1-3]. Despite their favorable long-term outcome, perioperative cerebral ischemia and cerebral hyper-perfusion are potential complications of these procedures [1, 4-6]. Patients with moyamoya disease are known to suffer from transient neurological deterioration in the acute stage after surgical revascularization at a substantial rate, and cerebral ischemia has been considered as the major reason for this deterioration . Recent investigations of the time-sequential cerebral hemodynamics in the acute stage after revascularization surgery for moyamoya disease, however, revealed that cerebral hyperperfusion as well as cerebral ischemia could result in transient neurologic deterioration after surgical revascularization [4-6]. In this chapter, the author seeks to focus on perioperative cerebral ischemia and cerebral hyperperfusion as potential complications, and discuss their risk factors. Prediction and accurate diagnosis of these pathologies is clinically important because the management of each of these conditions is contradictory.
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