Incidence and risk factors for symptomatic cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with moyamoya disease
Incidence and risk factors for symptomatic cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with moyamoya disease
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DOI：
10.1016/j.surneu.2008.02.031
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发表时间：
2009-04-01
影响因子：
--
通讯作者：
Tominaga, Teiji
中科院分区：
文献类型：
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作者：
Fujimura, Miki;Mugikura, Shun;Tominaga, Teiji
背景：烟雾病的颞浅动脉-大脑中动脉吻合术通过改善CBE来预防脑缺血发作，而最近的证据表明，尽管进行了低流量血运重建，术后脑过度灌注仍可能导致暂时性神经功能恶化。本研究调查了烟雾病患者 STA-MCA 吻合术后症状性血流灌注的发生率和危险因素。方法：我们前瞻性地对 58 名连续烟雾病患者（约 2-62 岁）的 80 个半球进行 STA-MCA 吻合术后 1 天和 7 天的 N-异丙基-p-（原文如此）碘苯丙胺单光子发射计算机断层扫描年龄，平均34.4岁）。平均随访期为 22.7 个月。症状性脑过度灌注定义为吻合部位CBF显着增加，导致明显的神经系统体征。 结果：21例患者（22侧，27.5%）暂时出现症状性脑过度灌注，并接受强化血压控制。术后磁共振成像/血管造影显示所有 21 名患者均出现旁路高信号，但没有缺血性变化。成人发病 (P = .013) 或出血发病患者 (P = .027) 出现症状性血过多的风险显着较高。各组术中临时封堵时间无差异。没有患者因过度灌注而出现永久性神经功能缺损。结论：STA-MCA 吻合术是烟雾病的一种安全有效的治疗方法，尽管成人发病和/或出血性发病的患者出现症状性过度灌注的风险较高。我们特别建议对这些患者进行常规 CBF 测量，因为过度灌注的处理与缺血的处理是矛盾的。 (c) 2009 Elsevier Inc. 保留所有权利。
Background: Superficial temporal artery-middle cerebral artery anastomosis for moyamoya disease prevents cerebral ischemic attack by improving CBE, whereas recent evidence suggests that the temporary neurologic deterioration because of postoperative cerebral hyperfusion could occur despite its low-flow revascularization. The present study investigates the incidence and the risk factors for symptomatic hyperfusion after STA-MCA anastomosis in patients with moyamoya disease.Methods: We prospectively performed N-isopropyl-p-(sic) iodoamphetamine single-photon emission computed tomography 1 and 7 days after STA-MCA anastomosis on 80 hemispheres of 58 consecutive patients with moyamoya disease (approximately 2-62 years old, 34.4 years old in average). Mean follow-up period was 22.7 months. Symptomatic cerebral hyperperfusion was defined as the presence of the significant increase in CBF at the site of the anastomosis that is responsible for the apparent neurologic sign.Results: Twenty-one patients (22 sides, 27.5%) temporarily had symptomatic cerebral hyperfusion, who were subjected of intensive blood pressure control. Postoperative magnetic resonance imaging/angiography showed the thiek high signal of bypass without ischemic changes in all 21 patients. Adult-onset (P = .013) or hemorrhagic-onset patients (P = .027) had significantly higher risk for symptomatic hyperfusion. There was no difference in intraoperative temporary occlusion time between each group. No patients had permanent neurologic deficit because of hyperperfusion.Conclusion: The STA-MCA anastomosis is a safe and effective treatment of moyamoya disease, although adult-onset and/or hemorrhagic-onset patients had higher risk for symptomatic hyperperfusion. We recommend routine CBF measurement especially for these patients because the management of hyperperfusion is contradictory to that of ischemia. (c) 2009 Elsevier Inc. All rights reserved.