Prediction of Cerebral Hyperperfusion after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis by Three-Dimensional-Time-of-Flight Magnetic Resonance Angiography in Adult Patients with Moyamoya Disease

Abstract

Introduction: Superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis is an effective surgical procedure for adult patients with moyamoya disease (MMD) and is known to have the potential to prevent cerebral ischemia and/or hemorrhagic stroke. Cerebral hyperperfusion (CHP) syndrome is one of the serious complications of this procedure that can result in deleterious outcomes, such as delayed intracerebral hemorrhage, but the prediction of CHP before revascularization surgery remains challenging. The present study evaluated the diagnostic value of preoperative three-dimensional (3D)-time-of-flight (TOF) magnetic resonance angiography (MRA) for predicting CHP after STA-MCA anastomosis for MMD. Materials and Methods: The signal intensity of the peripheral portion of the intracranial major arteries, such as the anterior cerebral artery (ACA), MCA, and posterior cerebral artery (PCA) ipsilateral to STA-MCA anastomosis, on preoperative MRA was graded (0-2 in each vessel) according to the ability to visualize each vessel on 97 affected hemispheres in 83 adult MMD patients. Local cerebral blood flow (CBF) at the site of anastomosis was quantitatively measured by N-isopropyl-p-[ 123 I]-iodoamphetamine single-photon emission computed tomography 1 and 7 days after surgery, in addition to the preoperative CBF value at the corresponding area. Then, we investigated the correlation between the preoperative MRA score and the development of CHP. Results: The CHP phenomenon 1 day after STA-MCA anastomosis (local CBF increase over 150% compared with the preoperative value) was evident in 27 patients (27/97 hemispheres; 28%). Among them, 8 (8 hemispheres) developed CHP syndrome. Multivariate analysis revealed that the hemispheric MRA score (0-6), the summed ACA, MCA, and PCA scores for the affected hemisphere, was significantly associated with the development of CHP syn-This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.

Cerebral Hyperperfusion and Concomitant Reversible Lesion at the Splenium after Direct Revascularization Surgery for Adult Moyamoya Disease: Possible Involvement of MERS and Watershed Shift Phenomenon

“… 35 , 36) In addition, splenial lesion in the present case may reflect generation of oxidative stress, inflammation, and intramyelin edema, as discussed previously. 25 , 26) Then, ADC values could be useful to detect reversible ischemia, although not only oxidative stress and inflammatory changes but also postoperative hemodynamic changes could participate in the formation of the splenial lesion in the current case. 26 – 28) Therefore, we strongly recommend serial quantitative 123 I-IMP-SPECT and MR imaging studies to detect dynamic and heterogenous postoperative changes in patients with MMD after STA–MCA anastomosis.…”

“… 1 , 3 , 13 , 23 , 24) In addition, recent report demonstrated preoperative MR angiography has also diagnostic value of CHP by assessment of signal intensity of intracranial major arteries. 25) Therefore, serial quantitative 123 I-IMP-SPECT and MR imaging studies are useful to detect dynamic and heterogenous postoperative hemodynamic changes.…”

“…1E ). Then we performed intensive management, such as strict blood pressure control (systolic blood pressure: 110–130 mmHg) and administration of minocycline hydrochloride, to avoid deleterious events due to CHP, 1 , 24 , 25) but the patient developed delirium on POD 4. Diffusion- weighted MR imaging revealed a high-signal- intensity lesion with a low apparent diffusion coefficient at the splenium ( Fig.…”

“…Then, the detection of heterogeneous hemodynamic and inflammatory changes and intensive postoperative management is critical after STA–MCA anastomosis for MMD. 10 , 13 – 15) To detect heterogenous and dynamic hemodynamic changes and perform intensive management, such as prophylactic blood pressure lowering 21) and administration of minocycline hydrochloride, 22) we have introduced serial [ 123 I] iodoamphetamine single-photon emission computed tomography ( 123 I-IMP-SPECT) 23 , 24) and MRI 25) studies in the acute phase of revascularization surgery for MMD. Among 525 consecutive revascularization surgeries for MMD patients, we report a rare patient who developed local CHP and concomitant remote reversible lesion at the splenium after STA–MCA bypass, with marked regression of periallosal artery.…”

RNF213 loss of function reshapes vascular transcriptome and spliceosome leading to disrupted angiogenesis and aggravated vascular inflammatory responses

“…MMD is characterized by progressive stenosis and occlusion of the internal carotid arteries (ICAs) and the development of basal brain collaterals 1,2 . While the standard-of-care, surgical treatment, and postoperative management of surgical complications have been fairly standardized in MMD therapy [2][3][4][5] , the etiology of MMD is not well understood.…”