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
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
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DOI：
10.1227/neu.0b013e318208f1da
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发表时间：
2011-04-01
期刊：
影响因子：
4.8
通讯作者：
Tominaga, Teiji
中科院分区：
文献类型：
--
作者：
Fujimura, Miki;Shimizu, Hiroaki;Tominaga, Teiji
背景：颞浅动脉-大脑中动脉（STA-MCA）吻合术通过改善闭塞性脑血管疾病和血流动力学受损患者的脑血流量来预防脑缺血发作。最近的证据表明，局灶性脑过度灌注是烟雾病手术的潜在并发症。目的：阐明患有和不患有烟雾病的患者之间这种现象的发生率和临床表现的确切差异。方法：对来自 121 个大脑半球的 STA-MCA 吻合术后 1 和 7 天进行 N-异丙基-p-[I-123]碘苯丙胺单光子发射计算机断层扫描86 名连续烟雾病患者（2-67 岁；平均 34.3 岁）和 28 名非烟雾病患者（12-67 岁；平均 56.5 岁）的 28 个半球。组间比较了症状性过度灌注的发生率，定义为吻合部位脑血流量显着增加，导致明显的神经系统体征。 结果：25 名烟雾病患者（26 个半球，21.5%）出现症状性脑过度灌注，包括轻度局灶性神经系统体征，但没有任何烟雾病患者出现症状性脑过度灌注（P = .0069）。多变量分析显示烟雾病与症状性脑过度灌注的发生显着相关 (P = .0008)。所有症状性脑过度灌注患者均通过强化血压控制得到缓解，且没有患者因过度灌注而出现永久性神经功能缺损。结论：症状性脑过度灌注是STA-MCA吻合术的潜在并发症，尤其是烟雾病患者。建议对过度灌注进行准确的诊断和充分的管理，特别是对于烟雾病患者。
BACKGROUND: Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis prevents cerebral ischemic attack by improving cerebral blood flow in patients with occlusive cerebrovascular disease and hemodynamic compromise. Recent evidence suggests that focal cerebral hyperperfusion is a potential complication of this procedure for moyamoya disease.OBJECTIVE: To clarify the exact differences in the incidence and clinical manifestations of this phenomenon between patients with and without moyamoya disease.METHODS: N-isopropyl-p-[I-123]iodoamphetamine single-photon emission computed tomography was performed 1 and 7 days after STA-MCA anastomosis on 121 hemispheres from 86 consecutive patients with moyamoya disease (2-67 years of age; mean, 34.3 years) and on 28 hemispheres from 28 non-moyamoya patients (12-67 years of age; mean, 56.5 years). The incidence of symptomatic hyperperfusion, defined as a significant focal increase in cerebral blood flow at the site of the anastomosis that is responsible for the apparent neurological signs, was compared between groups.RESULTS: Symptomatic cerebral hyperperfusion including mild focal neurological signs was seen in 25 patients with moyamoya disease (26 hemispheres, 21.5%) but in none of the patients without moyamoya disease (P = .0069). Multivariate analysis revealed that moyamoya disease was significantly associated with the development of symptomatic cerebral hyperperfusion (P = .0008). All patients with symptomatic hyperperfusion were relieved by intensive blood pressure control, and no patients suffered from permanent neurological deficit caused by hyperperfusion.CONCLUSION: Symptomatic cerebral hyperperfusion is a potential complication of STA-MCA anastomosis, especially in patients with moyamoya disease. Accurate diagnosis and adequate management of hyperperfusion are recommended, especially in patients with moyamoya disease.