Clinical implications of intraoperative infrared brain surface monitoring during superficial temporal artery–middle cerebral artery anastomosis in patients with moyamoya disease

Nakagawa, Atsuhiro; Fujimura, Miki; Arafune, Tatsuhiko; Sakuma, Ichiro; Tominaga, Teiji

doi:10.3171/2009.4.jns08585

Cited by 46 publications

(35 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, except for the most recent study by Kawamata et al [41], all the previous reports [2,3,10,11,12,13,14,15,16,17,18] lacked the quantitative definition of ‘hyperperfusion phenomenon’ in moyamoya disease. Our present study has a similar limitation, since we could not yet define the threshold of the ‘pathological increase in CBF after EC-IC bypass’ for moyamoya disease.…”

Section: Discussionmentioning

confidence: 91%

“…Despite the favorable long-term outcome of STA-MCA anastomosis for moyamoya disease [4,5,6], increasing evidence suggests that cerebral hyperperfusion syndrome, as has been well described in patients undergoing carotid endarterectomy (CEA) [7,8,9], is a potential complication of EC-IC bypass, especially for moyamoya disease. Focal cerebral hyperperfusion was reported to cause transient neurological deterioration [3,10,11,12,13,14,15,16] or delayed intracerebral hemorrhage (ICH) [17] during the acute stage after EC-IC bypass for moyamoya disease. Patients with moyamoya disease have a significantly higher risk for cerebral hyperperfusion syndrome than those with other occlusive cerebrovascular diseases based on routine postoperative cerebral blood flow (CBF) measurements using N-isopropyl- p -[ 123 I]-iodoamphetamine single-photon emission computed tomography ( 123 I-IMP-SPECT) [18].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of Prophylactic Blood Pressure Lowering according to a Standardized Postoperative Management Protocol to Prevent Symptomatic Cerebral Hyperperfusion after Direct Revascularization Surgery for Moyamoya Disease

Fujimura

Inoue

Shimizu³

et al. 2012

Cerebrovasc Dis

Self Cite

112

View full text Add to dashboard Cite

Background: Cerebral hyperperfusion is a potential complication of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease, but the optimal postoperative management has not been determined. Aggressive blood pressure lowering is controversial because of the risk of ischemic complications. Objective: To establish the optimal postoperative management protocol to prevent symptomatic cerebral hyperperfusion in moyamoya disease. Methods: N-isopropyl-p-[¹²³I]-iodoamphetamine single-photon emission computed tomography was performed 1 and 7 days after STA-MCA anastomosis on 152 hemispheres from 108 consecutive patients with moyamoya disease (2–69, mean 33.3 years). Between 2004 and 2007 (period 1), 65 patients were maintained under normotensive conditions after 93 operations, and only patients with cerebral hyperperfusion underwent blood pressure lowering. Between 2008 and 2010 (period 2), all 43 patients were prospectively subjected to intensive blood pressure lowering (<130 mm Hg of systolic blood pressure) immediately after 59 operations. Then the incidence of symptomatic cerebral hyperperfusion was compared between the two groups. Results: Systolic blood pressure the day after surgery was significantly lower in period 2 (mean, 120.9 mm Hg) than in period 1 (133.9 mm Hg) (p < 0.0001). Symptomatic cerebral hyperperfusion was seen in 22 patients during period 1 (23 hemispheres, 24.7%), but only in 4 patients during period 2 (6.7%, p = 0.0047). Multivariate analysis revealed that prophylactic blood pressure lowering was significantly associated with the prevention of symptomatic cerebral hyperperfusion (p = 0.015). Symptomatic cerebral hyperperfusion was relieved in all patients without developing a permanent neurological deficit due to cerebral hyperperfusion. Conclusion: Prophylactic blood pressure lowering prevents symptomatic cerebral hyperperfusion after STA-MCA anastomosis in patients with moyamoya disease. Accurate diagnosis of cerebral hyperperfusion and blood pressure lowering, and considering the severity of hemodynamic compromise in the contralateral and/or remote areas are essential for postoperative management of moyamoya disease.

show abstract

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Efficacy of Prophylactic Blood Pressure Lowering according to a Standardized Postoperative Management Protocol to Prevent Symptomatic Cerebral Hyperperfusion after Direct Revascularization Surgery for Moyamoya Disease

Fujimura

Inoue

Shimizu³

et al. 2012

Cerebrovasc Dis

Self Cite

112

View full text Add to dashboard Cite

show abstract

“…Because the pial artery network is markedly affected in moyamoya disease patients (Kim et al 2008;Nakagawa et al 2009), the STA-MCA bypass may temporarily lead to The scheme also shows the potential risk factors responsible for the peri-operative pathologies, such as focal cerebral hyperperfusion and local vasogenic edema.…”

Section: Cerebral Hyperperfusion Syndromementioning

confidence: 99%

“…Finally, the risk factors for hyperperfusion syndrome in moyamoya disease were reported as follows (Table 2); adult-onset (Fujimura et al 2009b;Uchino et al 2012), increased preoperative cerebral blood volume (Uchino et al 2012), hemorrhagic-onset (Fujimura et al 2009b), operation on the dominant (left) hemisphere (Hwang et al 2013; and smaller diameter of the recipient artery . We also reported the predictive value of intraoperative brain surface monitoring by infrared thermography for postoperative hypeperfusion syndrome (Nakagawa et al 2009). More recently, the predictive value of intraoperative indocyanine green video angiography findings for post-operative hyperperfusion was reported from different institutes Uchino et al 2014).…”

Section: Cerebral Hyperperfusion Syndromementioning

confidence: 99%

Current Status of Revascularization Surgery for Moyamoya Disease: Special Consideration for Its ‘Internal Carotid-External Carotid (IC-EC) Conversion’ as the Physiological Reorganization System

Fujimura

Tominaga

2015

Tohoku J. Exp. Med.

Self Cite

View full text Add to dashboard Cite

Moyamoya disease is a chronic cerebrovascular disease with unknown etiology, which is characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network formation at the base of the brain. Moyamoya disease is known to have unique and dynamic nature to convert the vascular supply for the brain from internal carotid (IC) system to the external carotid (EC) system, as indicated by Suzuki's angiographic staging established in 1969. Insufficiency of this 'IC-EC conversion system' may result in cerebral ischemia, as well as in intracranial hemorrhage from inadequate collateral vascular network, both of which represent the clinical presentation of moyamoya disease. Therefore, surgical revascularization by extracranial-intracranial bypass is the preferred procedure for moyamoya disease to complement 'IC-EC conversion' and thus to avoid cerebral infarction and/or intracranial hemorrhage. Long-term outcome of revascularization surgery for moyamoya disease is favorable, but rapid increase in cerebral blood flow on the affected hemisphere could temporarily cause unfavorable phenomenon such as cerebral hyperperfusion syndrome. We would review the current status of revascularization surgery for moyamoya disease based on its basic pathology, and sought to discuss the significance of measuring cerebral blood flow in the acute stage and intensive perioperative management.

show abstract

“…8,11) Poor vascular networks in moyamoya disease may explain why patients with moyamoya disease have higher risk for postoperative hyperperfusion. 18) However, cerebral hyperperfusion following surgical revascularization may rarely cause transient CCD. Actually, we treated 26 patients (40 sides) with surgical revascularization for adult-onset moyamoya disease at our hospital between April 2006 and July 2011, including this patient.…”

Section: Discussionmentioning

confidence: 99%

Transient Crossed Cerebellar Diaschisis Due to Cerebral Hyperperfusion Following Surgical Revascularization for Moyamoya Disease

Hokari

Kuroda

Simoda

et al. 2012

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Crossed cerebellar diaschisis (CCD) often occurs after ischemic or hemorrhagic stroke that damages the cortico-ponto-cerebellar pathway. However, CCD due to cerebral hyperperfusion following cerebrovascular reconstruction is rare. A 61-year-old woman presented with transient CCD due to cerebral hyperperfusion following bypass surgery for adult moyamoya disease. She developed transient weakness of the right extremities and was diagnosed with moyamoya disease. First, she underwent superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis with indirect synangiosis on the left. Postoperative course was uneventful. Subsequently, she underwent STA-MCA anastomosis with indirect synangiosis on the right. She complained of mild headache on the right, and single photon emission computed tomography (SPECT) performed on the 7th postoperative day demonstrated hyperperfusion in the right frontal and temporal lobes associated with hypoperfusion in the left cerebellum. Magnetic resonance (MR) imaging demonstrated no new lesions and MR angiography showed patent STA-MCA bypass. Subsequent SPECT showed disappearance of both hyperperfusion and CCD. This case strongly suggests that cerebral hyperperfusion after bypass surgery for moyamoya disease may cause transient CCD. Although the clinical significance is still obscure, this phenomenon indicates the cortico-ponto-cerebellar pathway is interrupted due to hyperperfusion, suggesting the development of hyperperfusion syndrome. Careful observation of cerebral hemodynamics after bypass surgery is warranted to avoid hyperperfusion-related complications.

show abstract

Clinical implications of intraoperative infrared brain surface monitoring during superficial temporal artery–middle cerebral artery anastomosis in patients with moyamoya disease

Abstract: 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.

Cited by 46 publications

References 22 publications

Efficacy of Prophylactic Blood Pressure Lowering according to a Standardized Postoperative Management Protocol to Prevent Symptomatic Cerebral Hyperperfusion after Direct Revascularization Surgery for Moyamoya Disease

Efficacy of Prophylactic Blood Pressure Lowering according to a Standardized Postoperative Management Protocol to Prevent Symptomatic Cerebral Hyperperfusion after Direct Revascularization Surgery for Moyamoya Disease

Current Status of Revascularization Surgery for Moyamoya Disease: Special Consideration for Its ‘Internal Carotid-External Carotid (IC-EC) Conversion’ as the Physiological Reorganization System

Transient Crossed Cerebellar Diaschisis Due to Cerebral Hyperperfusion Following Surgical Revascularization for Moyamoya Disease

Contact Info

Product

Resources

About