title: Significance of focal cerebral hyperperfusion as a cause of transient neurologic deterioration after extracranial-intracranial bypass for moyamoya disease: comparative study with non-moyamoya patients using N-isopropyl-p-[(123)I]iodoamphetamine single-photon emission computed tomography.
abstract: BACKGROUND
  Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis prevents cerebral ischemic attack by improving cerebral blood flow in patients with occlusive cerebrovascular disease and hemodynamic compromise. Recent evidence suggests that focal cerebral hyperperfusion is a potential complication of this procedure for moyamoya disease.
  
  
  OBJECTIVE
  To clarify the exact differences in the incidence and clinical manifestations of this phenomenon between patients with and without moyamoya disease.
  
  
  METHODS
  N-isopropyl-p-[(123)I]iodoamphetamine single-photon emission computed tomography was performed 1 and 7 days after STA-MCA anastomosis on 121 hemispheres from 86 consecutive patients with moyamoya disease (2-67 years of age; mean, 34.3 years) and on 28 hemispheres from 28 non-moyamoya patients (12-67 years of age; mean, 56.5 years). The incidence of symptomatic hyperperfusion, defined as a significant focal increase in cerebral blood flow at the site of the anastomosis that is responsible for the apparent neurological signs, was compared between groups.
  
  
  RESULTS
  Symptomatic cerebral hyperperfusion including mild focal neurological signs was seen in 25 patients with moyamoya disease (26 hemispheres, 21.5%) but in none of the patients without moyamoya disease (P = .0069). Multivariate analysis revealed that moyamoya disease was significantly associated with the development of symptomatic cerebral hyperperfusion (P = .0008). All patients with symptomatic hyperperfusion were relieved by intensive blood pressure control, and no patients suffered from permanent neurological deficit caused by hyperperfusion.
  
  
  CONCLUSIONS
  Symptomatic cerebral hyperperfusion is a potential complication of STA-MCA anastomosis, especially in patients with moyamoya disease. Accurate diagnosis and adequate management of hyperperfusion are recommended, especially in patients with moyamoya disease.
authors.affiliation: Department of Neurosurgery, Kohnan Hospital, Sendai, Japan. fujimur@kohnan-sendai.or.jp
authors.forename: Miki
authors.initials: M
authors.lastname: Fujimura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Takashi
authors.initials: T
authors.lastname: Inoue
authors.forename: Shunji
authors.initials: S
authors.lastname: Mugikura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Saito
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002548:Cerebral Revascularization / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes; D020367:Iofetamine; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D009072:Moyamoya Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011446:Prospective Studies; D013699:Temporal Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes; D020367:Iofetamine