Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). Symptomatic cerebral hyperperfusion is a potential complication of this procedure, but its treatment is contradictory to that for ischemia. Because intraoperative techniques to detect hyperperfusion are still lacking, the authors performed intraoperative infrared monitoring in moyamoya disease using a novel infrared imaging system.
During superficial temporal artery–middle cerebral artery anastomosis in 25 patients (26 hemispheres) with moyamoya disease, the authors monitored the brain surface temperature intraoperatively with the IRIS-V infrared imaging system. The average gradation value change (indicating temperature change) was calculated using commercial software. Magnetic resonance imaging, MR angiography, and N-isopropyl-p-[123I]iodoamphetamine SPECT studies were performed routinely before and within 10 days after surgery.
Patency of bypass, detailed local hemodynamics, and changes in cortical surface temperature around the anastomosis site were well recognized by the IRIS-V infrared imaging system in all cases. In the present study, 10 patients suffered transient neurological symptoms accompanied by an increase in CBF around the anastomosis site, recognized as symptomatic hyperperfusion. The increase in temperature was significantly higher in these patients. Intensive blood pressure control was undertaken, and free-radical scavengers were administered. No patient in the present study suffered a permanent neurological deficit.
Although the present method does not directly monitor surface CBF, temperature rise around the anastomosis site during surgery might be an indicator of postoperative hyperperfusion. Prospective evaluation with a larger number of patients is necessary to validate this technique.
Abbreviations used in this paper: CBF = cerebral blood flow; DW = diffusion weighted; EDMS = encephaloduromyosynangiosis; 123I-IMP = N-isopropyl-p-[123I]iodoamphetamine; MCA = middle cerebral artery; ROI = region of interest; STA = superficial temporal artery; TIA = transient ischemic attack.
Address correspondence to: Atsuhiro Nakagawa, M.D., Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan. email:
Please include this information when citing this paper: published online May 8, 2009; DOI: 10.3171/2009.4.JNS08585.
FalkVWaltherTPhilippiAAutschbachRKriegerHDalichauH: Thermal coronary angiography for intraoperative patency control of arterial and saphenous vein coronary artery bypass grafts: results in 370 patients. J Card Surg10:147–1601995
FujimuraMKanetaTMugikuraSShimizuHTominagaT: Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease. Surg Neurol67:273–2822007
FujimuraMMugikuraSShimizuHTominagaT: [Diagnostic value of perfusion-weighted MRI for evaluating postoperative alteration of cerebral hemodynamics following STAMCA anastomosis in patients with moyamoya disease.]. No Shinkei Geka34:801–8092006. Jpn
FuruyaKKawaharaNMoritaAMomoseTAokiSKirinoT: Focal hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in a patient with moyamoya disease. Case report. J Neurosurg100:128–1322004
NakagawaAFujimuraMOhkiTSuzukiHTakayamaKTominagaT: [Intraoperative brain surface blood flow monitoring using IRIS V thermographic imaging system in patients with Moyamoya disease.]. No Shinkei Geka34:1017–10252006. Jpn
NakagawaAHiranoTUenoharaHSatoMKusakaYShiraneR: Intraoperative thermal artery imaging of an EC-IC bypass in beagles with infrared camera with detectable wave-length band of 7-14 micron: possibilities as novel blood flow monitoring system. Minim Invasive Neurosurg46:231–2342003
NakagawaAHiranoTUenoharaHUtsunomiyaHSuzukiSTakayamaK: Use of intraoperative dynamic infrared imaging with detection wavelength of 7–14 micron in the surgical obliteration of spinal arteriovenous fistula: case report and technical considerations. Minim Invasive Neurosurg47:136–1392004
OgasawaraKKomoribayashiNKobayashiMFukudaTInoueTYamadateK: Neural damage caused by cerebral hyperperfusion after arterial bypass surgery in a patient with moyamoya disease: case report. Neurosurgery56:E13802005
ShiraneRYoshidaYTakahashiTYoshimotoT: Assessment of encephalo-galeo-myo-synangiosis with dural pedicle insertion in childhood moyamoya disease: characteristics of cerebral blood flow and oxygen metabolism. Clin Neurol Neurosurg99:Suppl 2S79–S851997
YoshimotoTHoukinKKurodaSAbeHKashiwabaT: Low cerebral blood flow and perfusion reserve induce hyperperfusion after surgical revascularization: case reports and analysis of cerebral hemodynamics. Surg Neurol48:132–1381997