Hemodynamic analysis of the recipient parasylvian cortical arteries for predicting postoperative hyperperfusion during STA-MCA bypass in adult patients with moyamoya disease

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OBJECTIVE

Superficial temporal artery–middle cerebral artery (STA-MCA) bypass is a common approach for treating moyamoya disease (MMD); however, the selection of recipient vessels is still controversial, and its relationship with postoperative cerebral hyperperfusion (CHP) has not been revealed. The aim of the study was to investigate the relationship between the hemodynamic sources of the recipient parasylvian cortical arteries (PSCAs) and the occurrence of postoperative CHP.

METHODS

The authors retrospectively analyzed the clinical data from 68 adult patients (75 hemispheres) with MMD who underwent STA-MCA bypass. Based on their hemodynamic sources from the MCA and non-MCAs, the PSCAs were classified as M-PSCAs and non–M-PSCAs, and their distributional characteristics were studied. Moreover, the patients’ demographics, incidence of postoperative CHP, and post- and preoperative relative cerebral blood flow values were examined.

RESULTS

The digital subtraction angiography analysis demonstrated that 40% (30/75) of the recipient PSCAs had no hemodynamic relationship with the MCA. The post- and preoperative relative cerebral blood flow values of the M-PSCA group were significantly higher than those of the non–M-PSCA group (p < 0.001). Multivariate analysis revealed that the hemodynamic source of PSCAs from the MCA was significantly associated with the development of focal (p = 0.003) and symptomatic (p = 0.021) CHP. Twelve (85.7%) of the 14 patients with symptomatic CHP and all 4 (100%) patients with postoperative hemorrhage were from the M-PSCA group.

CONCLUSIONS

This study revealed that direct anastomoses of PSCAs with anterograde hemodynamic sources from the MCA had a high risk of postoperative CHP during STA-MCA bypass in adult patients with MMD.

ABBREVIATIONS ACA = anterior cerebral artery; CBF = cerebral blood flow; CHP = cerebral hyperperfusion; CTA = CT angiography; CTP = CT perfusion; DSA = digital subtraction angiography; ECA = external carotid artery; ICA = internal carotid artery; MCA = middle cerebral artery; MMD = moyamoya disease; MTT = mean transit time; PCA = posterior cerebral artery; PSCA = parasylvian cortical artery; rCBF = relative CBF; STA-MCA = superficial temporal artery–MCA; TND = transient neurological deficit.
Article Information

Contributor Notes

Correspondence Jincao Chen: Zhongnan Hospital of Wuhan University, Wuhan, China. chenjincao2012@hotmail.com.INCLUDE WHEN CITING Published online December 27, 2019; DOI: 10.3171/2019.10.JNS191207.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    Fujimura MKaneta TMugikura SShimizu HTominaga T: Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease. Surg Neurol 67:2732822007

    • Search Google Scholar
    • Export Citation
  • 2

    Fujimura MNiizuma KEndo HSato KInoue TShimizu H: Quantitative analysis of early postoperative cerebral blood flow contributes to the prediction and diagnosis of cerebral hyperperfusion syndrome after revascularization surgery for moyamoya disease. Neurol Res 37:1311382015

    • Search Google Scholar
    • Export Citation
  • 3

    Fujimura MShimizu HInoue TMugikura SSaito ATominaga 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-[123I]iodoamphetamine single-photon emission computed tomography. Neurosurgery 68:9579652011

    • Search Google Scholar
    • Export Citation
  • 4

    Fujimura MTominaga T: Current status of revascularization surgery for Moyamoya disease: special consideration for its ‘internal carotid-external carotid (IC-EC) conversion’ as the physiological reorganization system. Tohoku J Exp Med 236:45532015

    • Search Google Scholar
    • Export Citation
  • 5

    Fukui M: Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis (‘moyamoya’ disease). Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Clin Neurol Neurosurg 99 (Suppl 2):S238S2401997

    • Search Google Scholar
    • Export Citation
  • 6

    Geri OShiran SIRoth JArtzi MBen-Sira LBen Bashat D: Vascular territorial segmentation and volumetric blood flow measurement using dynamic contrast enhanced magnetic resonance angiography of the brain. J Cereb Blood Flow Metab 37:344634562017

    • Search Google Scholar
    • Export Citation
  • 7

    Guzman RLee MAchrol ABell-Stephens TKelly MDo HM: Clinical outcome after 450 revascularization procedures for moyamoya disease. Clinical article. J Neurosurg 111:9279352009

    • Search Google Scholar
    • Export Citation
  • 8

    Haubrich CKruska WDiehl RRMöller-Hartmann WKlötzsch C: Dynamic autoregulation testing in patients with middle cerebral artery stenosis. Stroke 34:188118852003

    • Search Google Scholar
    • Export Citation
  • 9

    Hayashi TShirane RFujimura MTominaga T: Postoperative neurological deterioration in pediatric moyamoya disease: watershed shift and hyperperfusion. J Neurosurg Pediatr 6:73812010

    • Search Google Scholar
    • Export Citation
  • 10

    Houkin KIshikawa TYoshimoto TAbe H: Direct and indirect revascularization for moyamoya disease surgical techniques and peri-operative complications. Clin Neurol Neurosurg 99 (Suppl 2):S142S1451997

    • Search Google Scholar
    • Export Citation
  • 11

    Ishii DOkazaki TMatsushige TShinagawa KIchinose NSakamoto S: Postoperative dilatation of superficial temporal artery associated with transient neurologic symptoms after direct bypass surgery for moyamoya angiopathy. World Neurosurg 106:4354412017

    • Search Google Scholar
    • Export Citation
  • 12

    Januszewski JBeecher JSChalif DJDehdashti AR: Flow-based evaluation of cerebral revascularization using near-infrared indocyanine green videoangiography. Neurosurg Focus 36(2):E142014

    • Search Google Scholar
    • Export Citation
  • 13

    Kaku YIihara KNakajima NKataoka HFukuda KMasuoka J: Cerebral blood flow and metabolism of hyperperfusion after cerebral revascularization in patients with moyamoya disease. J Cereb Blood Flow Metab 32:206620752012

    • Search Google Scholar
    • Export Citation
  • 14

    Kashiwazaki DAkioka NKuwayama NHoukin KCzabanka MVajkoczy P: Berlin grading system can stratify the onset and predict perioperative complications in adult moyamoya disease. Neurosurgery 81:9869912017

    • Search Google Scholar
    • Export Citation
  • 15

    Kazumata KUchino HTokairin KIto MShiga TOsanai T: Cerebral hyperperfusion syndrome after revascularization surgery in moyamoya disease: region-symptom mapping and estimating a critical threshold. World Neurosurg 114:e388e3952018

    • Search Google Scholar
    • Export Citation
  • 16

    Kim JEOh CWKwon OKPark SQKim SEKim YK: Transient hyperperfusion after superficial temporal artery/middle cerebral artery bypass surgery as a possible cause of postoperative transient neurological deterioration. Cerebrovasc Dis 25:5805862008

    • Search Google Scholar
    • Export Citation
  • 17

    Ley-Pozo JWillmes KRingelstein EB: Relationship between pulsatility indices of Doppler flow signals and CO2-reactivity within the middle cerebral artery in extracranial occlusive disease. Ultrasound Med Biol 16:7637721990

    • Search Google Scholar
    • Export Citation
  • 18

    Liebeskind DS: Collateral circulation. Stroke 34:227922842003

  • 19

    Meyer IACereda CWCorreia PNZerlauth JBPuccinelli FRotzinger DC: Factors associated with focal computed tomographic perfusion abnormalities in supratentorial transient ischemic attacks. Stroke 49:68752018

    • Search Google Scholar
    • Export Citation
  • 20

    Miyamoto SYoshimoto THashimoto NOkada YTsuji ITominaga T: Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial. Stroke 45:141514212014

    • Search Google Scholar
    • Export Citation
  • 21

    Morisawa HKawamata TKawashima AHayashi MYamaguchi KYoneyama T: Hemodynamics and changes after STA-MCA anastomosis in moyamoya disease and atherosclerotic cerebrovascular disease measured by micro-Doppler ultrasonography. Neurosurg Rev 36:4114192013

    • Search Google Scholar
    • Export Citation
  • 22

    Nair AKDrazin DYamamoto JBoulos AS: Computed tomographic perfusion in assessing postoperative revascularization in moyamoya disease. World Neurosurg 73:9399e13 2010

    • Search Google Scholar
    • Export Citation
  • 23

    Okada YShima TNishida MYamane KYamada TYamanaka C: Effectiveness of superficial temporal artery-middle cerebral artery anastomosis in adult moyamoya disease: cerebral hemodynamics and clinical course in ischemic and hemorrhagic varieties. Stroke 29:6256301998

    • Search Google Scholar
    • Export Citation
  • 24

    Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis: Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis). Neurol Med Chir (Tokyo) 52:2452662012

    • Search Google Scholar
    • Export Citation
  • 25

    Scott RMSmith ER: Moyamoya disease and moyamoya syndrome. N Engl J Med 360:122612372009

  • 26

    Suzuki JTakaku A: Cerebrovascular "moyamoya" disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 20:2882991969

    • Search Google Scholar
    • Export Citation
  • 27

    Uchino HKuroda SHirata KShiga THoukin KTamaki 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 43:261026162012

    • Search Google Scholar
    • Export Citation
  • 28

    Uchino HNakayama NKazumata KKuroda SHoukin K: Edaravone reduces hyperperfusion-related neurological deficits in adult moyamoya disease: historical control study. Stroke 47:193019322016

    • Search Google Scholar
    • Export Citation
  • 29

    Zhang JXiong ZWang SHe YSun SWu X: Cyclooxygenase-2 and prostaglandin E2 are associated with middle cerebral artery occlusion and hemorrhage in patients with moyamoya disease. Curr Neurovasc Res 13:68742016

    • Search Google Scholar
    • Export Citation
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