Transient hyperperfusion after superficial temporal artery/middle cerebral artery bypass surgery as a possible cause of postoperative transient neurological deterioration.
BACKGROUND
This study was designed to investigate the relationship between transient neurological deterioration and changes in cerebral perfusion after superficial temporal artery/middle cerebral artery (STA-MCA) bypass.


METHODS
Clinical characteristics of the patients with postoperative transient neurological deterioration were analyzed in 120 STA-MCA bypass procedures for ischemic cerebral diseases, such as atherosclerotic disease and moyamoya disease. Serial brain single-photon emission computed tomography (SPECT) was performed on 25 patients before surgery and on the third and tenth postoperative days. The hemispheric perfusion on SPECT was calculated semi-quantitatively using statistical parametric mapping and a probabilistic brain atlas.


RESULTS
Among 120 procedures, there were 4 permanent postoperative neurological deficits (3.3%) and 20 postoperative transient neurologic deteriorations with unknown etiology (17%). In 25 patients analyzed for postoperative perfusion changes, cerebral perfusion increased on the third postoperative day and the increased perfusion negatively correlated with preoperative perfusion (correlation coefficient = -0.77; p < 0.001). Temporal changes and the location of transient hyperperfusion on SPECT correlated with the time course and neurological deficits associated with postoperative transient neurological deterioration in 3 patients.


CONCLUSIONS
Postoperative transient relative hyperperfusion is a common phenomenon and may be one of the causes of postoperative transient neurological deterioration after STA-MCA bypass surgery for ischemic cerebral diseases.
Kim
Jeong Eun
JE
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Oh
Chang Wan
CW
Kwon
O-Ki
OK
Park
Sukh Que
SQ
Kim
Sang Eun
SE
Kim
Yu Kyeong
YK
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001259:Ataxia / Q000209:etiology*; D002548:Cerebral Revascularization / Q000009:adverse effects*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D015427:Reperfusion Injury / Q000150:complications*; D013064:Speech Disorders / Q000209:etiology*; D013699:Temporal Arteries / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon