Crossed cerebellar diaschisis as an indicator of severe cerebral hyperperfusion after direct bypass for moyamoya disease
Crossed cerebellar diaschisis as an indicator of severe cerebral hyperperfusion after direct bypass for moyamoya disease
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DOI：
10.1007/s10143-020-01265-8
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发表时间：
2020-02
影响因子：
2.8
通讯作者：
Haruto Uchino;K. Kazumata;Masaki Ito;N. Nakayama;S. Kuroda;K. Houkin
中科院分区：
文献类型：
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作者：
Haruto Uchino;K. Kazumata;Masaki Ito;N. Nakayama;S. Kuroda;K. Houkin
脑部过度灌注(HP)使烟雾病(MMD)患者直接血运重建术后的病程复杂化。交叉性小脑错位被认为是幽门螺杆菌血运重建术后罕见的并发症。本研究旨在描述MMD血运重建术后继发于脑幽门螺杆菌的脑出血的临床特征及相关因素。我们分析了150个连续的大脑半球，包括101个成人和49个儿童患者，他们接受了联合直接和间接搭桥治疗MMD。术后即刻、术后第2、7天应用单光子发射计算机断层扫描(SPECT)测量脑血流量(CBF)，并对SPECT结果进行体素分析，比较局部脑血流量的变化。采用多因素Logistic回归分析，检验多个变量对Ccd的影响。无症状者占41.3%(62/150)，有症状者占16.7%(25/150)。Hp检查发现18.4%(16/87)的大脑半球可见Ccd。多因素分析显示肝豆状核变性的发生与有症状的幽门螺杆菌显著相关(p= 0.0015)。体素分析显示，有症状Hp患者第7天手术侧额叶皮质脑血流量增加，对侧小脑半球脑血流量下降(中位数11.3%vs7.5%；− 6.0%vs− 1.7%)。术后Hp继发的Ccd在MMD中比预期的更常见。CCD值可作为MMD患者术后Hp严重程度的一个指标。
Cerebral hyperperfusion (HP) complicates the postoperative course of patients with moyamoya disease (MMD) after direct revascularization surgery. Crossed cerebellar diaschisis (CCD) has been considered to be rarely associated with HP after revascularization surgery. This study aimed to describe the clinical features and factors associated with CCD secondary to cerebral HP after revascularization surgery for MMD. We analyzed 150 consecutive hemispheres including 101 in adults and 49 in pediatric patients who underwent combined direct and indirect bypass for MMD. Using single-photon emission computed tomography (SPECT), serial cerebral blood flow (CBF) was measured immediately after the surgery and on postoperative days 2 and 7. Pre- and postoperative voxel-based analysis of SPECT findings was performed to compare the changes in regional CBF. Multivariate logistic regression analysis was performed to test the effect of multiple variables on CCD. Asymptomatic and symptomatic HP was observed in 41.3% (62/150) and 16.7% (25/150) of the operated hemispheres, respectively. CCD was observed in 18.4% (16/87) of these hemispheres with radiological HP. Multivariate analysis revealed that the occurrence of CCD was significantly associated with symptomatic HP (p= 0.0015). Voxel-based analysis showed that the CBF increase in the operated frontal cortex, and the CBF reduction in the contralateral cerebellar hemisphere on day 7 were significantly larger in symptomatic HP than in asymptomatic HP (median 11.3% vs 7.5%; − 6.0% vs − 1.7%, respectively). CCD secondary to postoperative HP is more common than anticipated in MMD. CCD could potentially be used as an indicator of severe postoperative HP in patients with MMD.