Predicting the Occurrence of Hemorrhagic Cerebral Hyperperfusion Syndrome Using Regional Cerebral Blood Flow After Direct Bypass Surgery in Patients with Moyamoya Disease.
OBJECTIVE
Superficial temporal artery-middle cerebral artery anastomosis is an established treatment for moyamoya disease. However, hemorrhagic cerebral hyperperfusion syndrome (CHS) leads to poor outcomes. This study aimed to identify predictors of hemorrhagic CHS based on regional cerebral blood flow (rCBF) in patients with moyamoya disease.


METHODS
The study included 251 hemispheres in 155 patients with moyamoya disease who underwent preoperative and postoperative rCBF measurements and superficial temporal artery-middle cerebral artery double anastomosis. We used rCBF increase rate for predicting hemorrhagic CHS. rCBF increase rate was calculated by 2 methods. In method 1, the rCBF value on the operated side was compared with the rCBF value on the nonoperated side. In method 2, the postoperative rCBF value on the operated side was compared with the preoperative rCBF value on the operated side. Patients were classified into 4 groups according to rCBF increase rate to predict risk of hemorrhagic CHS.


RESULTS
Hemorrhagic CHS occurred in 7 (2.8%) hemispheres (no children). Severe hemorrhagic CHS occurred in only 1 (0.4%) hemisphere. Hemorrhagic CHS was observed in patients with ≥30% rCBF increase according to method 1 and ≥50% rCBF increase according to method 2 and was most frequently noted in ≥100% rCBF increase.


CONCLUSIONS
Predictors for hemorrhagic CHS were ≥30% rCBF increase when using method 1 and ≥50% increase when using method 2.
['Ishikawa|Tatsuya|T|', 'Yamaguchi|Koji|K|', 'Kawashima|Akitsugu|A|', 'Funatsu|Takayuki|T|', 'Eguchi|Seiichiro|S|', 'Matsuoka|Go|G|', 'Nomura|Shunsuke|S|', 'Kawamata|Takakazu|T|']
D000293:Adolescent D000328:Adult D000368:Aged D000714:Anastomosis, Surgical D002548:Cerebral Revascularization D002560:Cerebrovascular Circulation D002648:Child D005260:Female D006801:Humans D020299:Intracranial Hemorrhage, Hypertensive D018810:Magnetic Resonance Angiography D008297:Male D008875:Middle Aged D009072:Moyamoya Disease D011183:Postoperative Complications D013577:Syndrome D014057:Tomography, X-Ray Computed D055815:Young Adult
Hyperperfusion syndrome Cerebral blood flow Bypass surgery Moyamoya disease Cerebral hemorrhage Postoperative management