title: Predictors and clinical features of postoperative hyperperfusion after surgical revascularization for moyamoya disease: a serial single photon emission CT/positron emission tomography study.
abstract: OBJECTIVE
  Clinical features and pathophysiology of postoperative hyperperfusion in moyamoya disease are still unclear. This study was aimed to clarify the incidence and time course of postoperative hyperperfusion and to determine the independent predictors of postoperative hyperperfusion in moyamoya disease.
  
  
  METHODS
  This prospective study included 41 patients who underwent surgical revascularization for moyamoya disease. Using (15)O-gas positron emission tomography, hemodynamic and metabolic parameters were quantified before surgery. Using single photon emission computed tomography, cerebral blood flow was serially measured just after surgery and on 2 and 7 days postsurgery. A multivariate logistic regression analysis was conducted to test the effect of multiple variables on postoperative hyperperfusion.
  
  
  RESULTS
  Postoperative hyperperfusion was observed in 29 (50.0%) of 58 operated hemispheres. The incidence of both radiological and symptomatic hyperperfusion was significantly higher in adult patients than in pediatric ones (P=0.026 and P=0.0037, respectively). Hyperperfusion just after surgery more often led to subsequent neurological deficits (P=0.033). A multivariate analysis revealed that preoperative cerebral blood volume increase was an independent predictor of both radiological and symptomatic hyperperfusion after surgery in adult moyamoya disease (OR, 6.6 and 12.3, respectively).
  
  
  CONCLUSIONS
  Postoperative hyperperfusion after surgical revascularization is not rare in moyamoya disease. Adult patients with a cerebral blood volume increase may be at high risk for radiological and symptomatic hyperperfusion after surgery. Careful perioperative management would reduce surgical complications and improve long-term outcome in moyamoya disease.
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
authors.forename: Haruto
authors.initials: H
authors.lastname: Uchino
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroda
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirata
authors.forename: Tohru
authors.initials: T
authors.lastname: Shiga
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
authors.forename: Nagara
authors.initials: N
authors.lastname: Tamaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001810:Blood Volume / Q000502:physiology*; D002548:Cerebral Revascularization; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D019990:Perioperative Care; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult