Intraoperative acute brain swelling when performing indirect anastomosis in a patient with moyamoya disease -A case report-

Nho, Ji-Sung; Choi, Soo Eun; Yi, Jae-Woo; Kang, Jong-Man

doi:10.4097/kjae.2010.59.s.s191

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…Unilateral direct bypass in symptomatic hemispheres of MMD patients could cause impairment of cerebrovascular regulation in primary asymptomatic hemispheres shortly after surgery, which may result in the occurrence of infarction and hemorrhage in the whole brain 62 , 63 . Even anesthesia can induce intraoperative, acute brain swellin 64 .…”

Section: Postoperative Infarction and Non-hs-induced Hemorrhagementioning

confidence: 99%

Progress on Complications of Direct Bypass for Moyamoya Disease

Shi

Guo

et al. 2016

Int. J. Med. Sci.

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Moyamoya disease (MMD) involves progressive occlusion of the intracranial internal carotid artery resulting in formation of moyamoya-like vessels at the base of the brain. It can be characterized by hemorrhage or ischemia. Direct vascular bypass is the main and most effective treatment of MMD. However, patients with MMD differ from those with normal cerebral vessels. MMD patients have unstable intracranial artery hemodynamics and a poor blood flow reserve; therefore, during the direct bypass of superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis, perioperative risk factors and anesthesia can affect the hemodynamics of these patients. When brain tissue cannot tolerate a high blood flow rate, it becomes prone to hyperperfusion syndrome, which leads to neurological function defects and can even cause intracranial hemorrhage in severe cases. The brain tissue is prone to infarction when hemodynamic equilibrium is affected. In addition, bypass vessels become susceptible to occlusion or atrophy when blood resistance increases. Even compression of the temporalis affects bypass vessels. Because the STA is used in MMD surgery, the scalp becomes ischemic and is likely to develop necrosis and infection. These complications of MMD surgery are difficult to manage and are not well understood. To date, no systematic studies of the complications that occur after direct bypass in MMD have been performed, and reported complications are hidden among various case studies; therefore, this paper presents a review and summary of the literature in PubMed on the complications of direct bypass in MMD.

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Section: Postoperative Infarction and Non-hs-induced Hemorrhagementioning

confidence: 99%

Progress on Complications of Direct Bypass for Moyamoya Disease

Shi

Guo

et al. 2016

Int. J. Med. Sci.

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“…Similarly, these fragile cerebral blood vessels with impaired cerebrovascular regulation have tendency for postoperative infarction and hemorrhage involving the asymptomatic cerebral hemisphere as well 6 . One previous study 7 has also reported acute brain swelling intraoperatively due to anesthesia.…”

Section: Technical Notementioning

confidence: 91%

Revascularization Procedures for Moyamoya Disease without Mayfield Skull Clamp

Fatima

Dine

Barnard

et al. 2022

Preprint

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Moyamoya disease (MMD) is a pathophysiologically complex disorder characterized by progressive stenosis of the internal carotid arteries at the skull base and formation of circuitous and expanded collaterals angiographically “puff of smoke” at the base of brain. However, these collateral blood vessels are fragile and prone to ischemic or hemorrhagic events during the peri and intra-operative period. Direct and indirect bypass techniques have been devised with the goal of promoting angiogenesis, inducing formation of collateral vessels, and restoring perfusion to the oxygen deprived area of the brain. Mayfield skull clamp can cause blood pressure instability. This technical note highlights the surgical management of MMD without the use of Mayfield skull clamp with the goal of minimizing risk of perioperative blood pressure volatility.

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