Cerebral Hyperperfusion Syndrome After Superficial Temporal Artery-middle Cerebral Artery Bypass for Severe Intracranial Steno-occlusive Disease

Teo, Kejia; Choy, David Kim Seng; Lwin, Sein; Chou, Ning; Yeo, Tseng Tsai; Shen, Liang; Chong, Vincent; Teoh, Hock Luen; Seet, Raymond C.S.; Chan, Bernard P.L.; Sharma, Arvind; Sharma, Vijay K

doi:10.1227/neu.0b013e31828bb8b3

Cited by 16 publications

(13 citation statements)

References 36 publications

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“…There is also a general agreement, among by-pass surgeons, to use end to side anastomosis as the main form of anastomosis for most cases of cerebral revascularization. [ 22 23 24 ] All our cases were operated using a standard end to side anastomosis technique with two anchoring stitches at the heel and at the toe. However, only very recently, we have started to use a “one-way up suture technique” with only one anchoring suture at the heel.…”

Section: Discussionmentioning

confidence: 99%

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Extracranial to intracranial by-pass anastomosis: Review of our preliminary experience from a low volume center in Egypt

et al. 2015

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Background:Cerebral revascularization is a useful microsurgical technique for the treatment of steno-occlusive intracranial ischemic disease, complex intracranial aneurysms that require deliberate occlusion of a parent artery and invasive skull base tumors. We describe our preliminary experience with extracranial-to-intracranial by-passes at a low volume center; and discuss clinical indications and microsurgical techniques, challenges in comparison to large advanced referral centers.Materials and Methods:Twenty-seven patients with hemodynamic ischemia or complex aneurysms or skull base tumors were operated at Cairo University Hospitals in the period between May 2009 and June 2014. All patients operated by a low flow by-pass were operated through a superficial temporal artery to middle cerebral artery (MCA) anastomosis. All patients chosen for a high flow by-pass were operated using a radial artery graft interposed between the MCAs distally and the common or the external carotid artery proximally. Patency was confirmed at the end of surgery using appearance on the table and confirmed after surgery by transcranial color-coded duplex or computed tomography angiography. All patient data were prospectively collected and retrospectively analyzed at the end of surgery.Results:Nineteen patients (70.4%) were operated upon for flow augmentation and eight patients (29.6%) were operated upon for flow replacement. A total of 30 anastomoses were performed. All except one were patent which gives a patency rate of 96.3%. There was one death in the present series resulting from a hyperperfusion syndrome. 89.5% of patients with hemodynamic ischemia stopped having symptoms after surgery. All but one patient operated for hemodynamic ischemia showed a considerable cognitive improvement after surgery. None of the patients operated upon for flow replacement showed improvement of oculomotor nerve function in spite of adequate intraoperative decompression. All patients treated for flow replacement showed the absence of recurrence on follow-up.Conclusion:Our initial results for both low and high flow by-pass procedures in our low volume center indicate that such complex surgical procedures are possible with results comparable to those obtained in other larger referral centers throughout the world. This procedure not only represents a more definitive treatment when compared to other endovascular or radiation treatments but is also much less costly when compared to other treatment modalities.

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Section: Discussionmentioning

confidence: 99%

“…This coincides with the work of a number of authors performing by-pass for flow replacement. [ 11 18 24 ]…”

Section: Discussionmentioning

confidence: 99%

Extracranial to intracranial by-pass anastomosis: Review of our preliminary experience from a low volume center in Egypt

et al. 2015

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“…In our case, the findings from postoperative angiography and SPECT demonstrated hyperperfusion, not hypoperfusion, in the frontal lobe immediately following surgery. It is well known that hyperperfusion can cause a variety of neurological deficits following STA–MCA anastomosis,[ 6 12 39 ] carotid endarterectomy (CEA),[ 37 ] obliteration of arteriovenous malformation,[ 34 ] and clipping of giant aneurysms. [ 19 23 35 ] We presume that abrupt elimination of the giant aneurysm from the M1 segment, which had long served as a buffering reservoir, may have led to a massively increased blood flow in the cortical MCA territory, resulting in dysfunction of the frontal cortical and subcortical motor pathways.…”

Section: Discussionmentioning

confidence: 99%

Hemichorea-hemiballismus caused by postoperative hyperperfusion after clipping of a giant unruptured middle cerebral artery aneurysm

Oya¹,

Fujisawa²,

Matsui³

2015

Surg Neurol Int

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Background:Movement disorders after the clipping for an unruptured giant aneurysm are rare. The information on the pathogenesis and treatment options for this condition is largely unknown.Case Description:An 82-year-old female with no neurological deficits underwent a clipping for a giant middle cerebral artery (MCA) aneurysm. Immediately after surgery, she presented with hemichorea–hemiballismus (HC–HB) on the left side. Postoperative angiograms and single-photon emission computed tomography demonstrated the hyperperfusion in the right frontal cortex and the decreased perfusion in the basal ganglia, indicating that the abrupt hemodynamic changes due to the obliteration of the giant aneurysm caused the dysfunction of the frontal cortical and subcortical pathway and the basal ganglia. Administration of tiapride hydrochloride was dramatically effective in controlling the HC–HB until the hyperperfusion resolved. Single-photon emission computed tomography obtained 8 weeks after surgery revealed that the cerebral blood flow had been normalized in the right frontal cortex. The relative hypoperfusion of the right basal ganglia was also resolved. Then tiapride hydrochloride was discontinued without a relapse of HC–HB.Conclusion:This case appears consistent with the theory that the connecting fibers responsible for the development of HC–HB are also located in the frontal lobe. The treatment of giant aneurysms involving the M1 portion can cause abrupt hemodynamic changes in both frontal cortex and the basal ganglia, which can potentially induce postoperative movement disorders.

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“…The incidence of cerebral hyperperfusion in patients with occlusive cerebrovascular disease is reported at 17% after bypass surgeries, and 0.4% to 20% after carotid endarterectomy [63]. In another study, the incidence of CHS in MMD patients after direct surgical revascularization was reported to be 21.5% [64].…”

Section: Cerebral Hyperfusion Syndrome (Chs)mentioning

confidence: 98%

“…In another study, the incidence of CHS in MMD patients after direct surgical revascularization was reported to be 21.5% [64]. Adult-onset, hemorrhagic presentation, and increased preoperative cerebral blood volume were the risk factors for developing CHS [63]. The most common symptoms are transient neurological deficits, followed by hemorrhage and seizure [65].…”

Section: Cerebral Hyperfusion Syndrome (Chs)mentioning

confidence: 98%

Perioperative Considerations for Revascularization and Non-Revascularization Surgeries in Moyamoya Disease

Khan¹,

Hassan²,

Aboobacker³

et al. 2021

Moyamoya Disease - A Disease to Count on in Your Daily Practice

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Moyamoya disease is a rare, progressive cerebrovascular occlusive disease; characterized by narrowing of the distal internal carotid arteries and their branches. The incidence is high in East Asians and most commonly presents in the first and fourth decade of life. Its symptoms are headaches, seizures, transient neurological deficits, and cognitive decline. Medical management is based on treating the symptoms and includes antiplatelet and anti-seizure medications. Surgical revascularization is the mainstay of treatment. Unique pathophysiology of moyamoya disease necessitates neuro-anesthesiologists to formulate an individualized plan perioperatively. The overriding goal of perioperative anesthetic management of moyamoya disease is to ensure optimal cerebral perfusion and protection. Maintenance of normotension, normocarbia, normo-oxygenation, normothermia, and euvolemia is the cornerstone during the perioperative period. Perioperative adequate analgesia is crucial to prevent cerebral ischemia and allows close neurological monitoring. This chapter reviews perioperative anesthetic management of patients with moyamoya disease.

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Cerebral Hyperperfusion Syndrome After Superficial Temporal Artery-middle Cerebral Artery Bypass for Severe Intracranial Steno-occlusive Disease

Abstract: Symptomatic cerebral HPS is common in the early postoperative period after EC-IC bypass surgery. Early diagnosis and appropriate management might prevent the complications of this syndrome.

Cited by 16 publications

References 36 publications

Extracranial to intracranial by-pass anastomosis: Review of our preliminary experience from a low volume center in Egypt

Extracranial to intracranial by-pass anastomosis: Review of our preliminary experience from a low volume center in Egypt

Hemichorea-hemiballismus caused by postoperative hyperperfusion after clipping of a giant unruptured middle cerebral artery aneurysm

Perioperative Considerations for Revascularization and Non-Revascularization Surgeries in Moyamoya Disease

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