Cerebral hyperperfusion syndrome following revascularization surgery in moyamoya disease: region-symptom mapping and estimating a critical threshold.

Cerebral hyperperfusion syndrome following revascularization surgery in moyamoya disease: region-symptom mapping and estimating a critical threshold.

World Neurosurg. 2018 Mar 09;:

Authors: Kazumata K, Uchino H, Tokairin K, Ito M, Shiga T, Osanai T, Kawabori M

Abstract
BACKGROUND: Cerebral hyperperfusion complicates the postoperative course of patients with moyamoya disease (MMD) following direct revascularization surgery. There is no clear distinction between cerebral hyperperfusion syndrome and benign postoperative increase in regional cerebral blood flow (rCBF).
OBJECTIVE: The present study aimed to determine clinically relevant changes in rCBF, anatomical correlations, and factors associated with transient neurological symptoms following revascularization surgery in MMD.
METHODS: Whole-brain voxel-based perfusion mapping was employed to identify regions involved in cerebral hyperperfusion and quantify the changes in 105 hemispheric surgeries, using single-photon computed tomography acquired on postoperative day 7. The changes in rCBF were quantitatively analyzed, and associations with cerebral hyperperfusion syndrome were determined.
RESULTS: Transient neurological symptoms appeared with rCBF increase in 37.9% of adults. Speech impairments were associated with an increase in rCBF in the operculo-insula region. Cheiro-oral syndrome was associated with the posterior insula as well as the prefrontal region. A receiver operating curve analysis yielded transient neurological symptoms with maximum accuracy at >15.5% increase from baseline. Age and preoperative rCBF were independently associated with transient neurological symptoms (p < 0.001).
CONCLUSIONS: Areas showing rCBF increase during the experience of transient neurological symptoms were spatially compatible with the known functional anatomy of the brain. An increase of approximately 15% from baseline was found to be critical, which is a far lower threshold than what has previously been reported. Increasing age was significantly associated with the occurrence of symptomatic hyperperfusion. Furthermore, patients with preserved rCBF also showed symptomatic hyperperfusion.

PMID: 29530706 [PubMed - as supplied by publisher]

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