Low cerebral blood flow and perfusion reserve induce hyperperfusion after surgical revascularization: Case reports and analysis of cerebral hemodynamics

Yoshimoto, Tetsuyuki; Houkin, Kiyohiro; Kuroda, Satoshi; Abe, Hiroshi; Kashiwaba, Takeshi

doi:10.1016/s0090-3019(97)90106-3

Cited by 90 publications

(56 citation statements)

References 15 publications

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“…Previous studies have revealed that preoperative persistent dilation of resistance vessels is the most likely cause of postoperative hyperperfusion after surgical revascularization such as CEA and STA-MCA anastomosis. 15,20,21,23,24,26) Hyperperfusion syndrome includes headache, seizure, focal neurological deficits, and intracerebral hemorrhage, and is sometimes lethal. 23) Nowadays, such vascular conditions can be identified as a decrease in cerebral perfusion reserve, using SPECT and PET, and may be a significant predictor for postoperative hyperperfusion.…”

Section: Discussionmentioning

confidence: 99%

“…12) Cerebral hyperperfusion is known to occur after revascularization surgery, including carotid endarterectomy (CEA) and superficial temporal artery to MCA (STA-MCA) anastomosis. 15,20,21,23,24,26) In particular, cerebral hyperperfusion syndrome occurs in about 30% of adult patients with moyamoya disease after STA-MCA anastomosis. 5) However, there are few reports of CCD due to cerebral hyperperfusion after bypass surgery.…”

Section: Introductionmentioning

confidence: 99%

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

Hokari

Kuroda

Simoda

et al. 2012

Neurol. Med. Chir.(Tokyo)

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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)

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“…10) Patients showing misery perfusion or poor CVR below 10% were considered to have high risk of postoperative hyperperfusion. Furthermore, the pressure measured at the distal portion of the ipsilateral carotid artery (distal pressure) appeared to be closely related to the postoperative hyperperfusion in such high risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…Hyperperfusion syndrome is one of the most serious complications of carotid endarterectomy (CEA) and may also occur after superficial temporal arterymiddle cerebral artery (STA-MCA) anastomosis, 10) as well as in a few patients following revascularization surgery. 1,3,6,7) Preoperatively, patients with a high risk of postoperative hyperperfusion can be identified based on preoperative perfusion data such as severe hypoperfusion and poor cerebrovascular reserve (CVR) below 10%, 10) and intraoperative stump pressure below 40 mmHg.…”

Section: Introductionmentioning

confidence: 99%

“…1,3,6,7) Preoperatively, patients with a high risk of postoperative hyperperfusion can be identified based on preoperative perfusion data such as severe hypoperfusion and poor cerebrovascular reserve (CVR) below 10%, 10) and intraoperative stump pressure below 40 mmHg. 11) In such patients, blood pressure should be strictly controlled immediately following the restoration of cerebral blood flow (CBF) by revascularization surgery.…”

Section: Introductionmentioning

confidence: 99%

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Stepwise Revascularization for Prevention of Postoperative Hyperperfusion

Yoshimoto¹,

Shirasaka²,

Yoshidumi³

et al. 2006

Neurol. Med. Chir.(Tokyo)

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Abrupt normalization of cerebral blood flow (CBF) after surgical procedures to improve excessive cerebral hypoperfusion can cause irreversible brain parenchymal damage. Such hyperperfusion, which is caused by inflow at normal blood pressure into maximally dilated fine vessels, is an important complication following carotid endarterectomy (CEA). Strict control of blood pressure in the perioperative period can prevent this complication except in a few patients, who have severe cerebral hypoperfusion and poor cerebrovascular reserve due to extremely severe stenosis of the ipsilateral or the bilateral carotid arteries, for which CEA is indicated. The requirement for improved CBF and the risk of postoperative hyperperfusion conflict in the pathogenesis of these patients. We tried to prevent abrupt improvement in perfusion by attempting gradual restoration of CBF. Superficial temporal arterymiddle cerebral artery anastomosis was first performed to improve the poor cerebrovascular reserve by allowing insufficient blood flow. A few weeks later, CEA was performed to completely restore CBF. This surgical approach obtained good results without postoperative problems in four patients. The indications of this surgical management and efficacy of stepwise restoration of CBF to prevent postoperative hyperperfusion depend on careful preoperative evaluation of perfusion studies.

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