Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease.
BACKGROUND
Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving CBF, but little is known about the change in CBF and its effect on neurologic status during the acute stage after revascularization.


METHODS
123I-IMP-SPECT was performed 1 and 7 days after STA-MCA anastomosis on 34 sides of 27 consecutive patients with adult-onset moyamoya disease (6 men, 21 women; 22-62 years old). The follow-up period ranged from 5 to 28 months (mean, 17.6 months).


RESULTS
Thirteen patients (13 sides, 38.2%) suffered temporary neurologic deterioration due to hyperperfusion several days after surgery, which was sustained for several days (7.4 days in average). Postoperative magnetic resonance imaging/angiography showed the STA as a higher intensity signal than the preoperative finding without ischemic changes in all 13 patients. Postoperative SPECT revealed focal intense increase in CBF at the sites of anastomosis in all 13 patients. Eleven patients (32.4%) had transient focal neurologic deficit mimicking ischemic attack. Two patients (5.9%) had cerebral hyperperfusion syndrome associated with subarachnoid hemorrhage extending to the ipsilateral sylvian cistern. Symptoms were relieved by intensive blood pressure control, and no patients had permanent neurologic deficit or delayed neurologic deterioration during the follow-up period.


CONCLUSIONS
Surgical revascularization including STA-MCA anastomosis is a safe and effective treatment for moyamoya disease, although temporary neurologic deterioration due to hyperperfusion could occur at a substantial rate. Routine CBF measurement is recommended for accurate diagnosis of postoperative hyperperfusion in moyamoya disease because its treatment is contradictory to that for ischemia.
Fujimura
Miki
M
Department of Neurosurgery, Tohoku University School of Medicine, Sendai 980-8574, Japan. fujimur@nsg.med.tohoku.ac.jp
Kaneta
Tomohiro
T
Mugikura
Shunji
S
Shimizu
Hiroaki
H
Tominaga
Teiji
T
D000328:Adult; D000367:Age Factors; D000714:Anastomosis, Surgical / Q000379:methods; D001037:Aphasia / Q000175:diagnosis / Q000209:etiology*; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002548:Cerebral Revascularization; D002560:Cerebrovascular Circulation / Q000502:physiology; D004401:Dysarthria / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D009072:Moyamoya Disease / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology*; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications; D011859:Radiography; D013699:Temporal Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon