title: Analysis of ischemic cerebral lesions using 3.0-T diffusion-weighted imaging and magnetic resonance angiography after revascularization surgery for ischemic disease.
abstract: BACKGROUND
  Cerebral revascularization surgery (CRS) is increasingly recognized as an important component in the treatment of complex cerebral vascular disease and tumors. CRS requires that the incidence of perioperative neurological complications should be minimized, because CRS for ischemic disease is often not the goal of treatment, but rather a prophylactic surgery. CRS carries the risk of focal postoperative neurological deficits. Little has been established concerning mechanisms of post-CRS ischemia. We used 3.0-T diffusion-weighted magnetic resonance imaging (DWI) and magnetic resonance angiography (MRA) to analyze the incidence and mechanism of ischemic lesions.
  
  
  METHODS
  We studied the anterior circulation territory after 20 CRS procedures involving 33 vascular anastomosis procedures (13 double anastomoses and 7 single anastomoses) in 12 men and 8 women between June 2007 and October 2011. The operations included single or double superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis to treat internal carotid artery/MCA occlusions or severe MCA stenosis. A combined STA-MCA anastomosis and indirect bypass were performed for moyamoya disease. Postoperative DWI and MRA were obtained in all patients between 24 and 96 h after surgery to detect thromboembolism, hypoperfusion, or procedural ischemic complications and vasospasms of the donor STA.
  
  
  RESULTS
  Follow-up DWI and MRA were carried out 1.8±0.6 days after CRS (range, 1-4 days). Temporary occlusion time for anastomoses averaged 18.9 min (range, 16-32 min). Asymptomatic new hyperintensities occurred in the ipsilateral hemisphere of 2 patients on postoperative DWI (10% patients/6.0% anastomoses), and 1 moyamoya patient (5.0% patients/3.0% anastomoses) developed a symptomatic hyperintensity in the ipsilateral occipital lobe in response to the operation. Two abnormal small (<5 mm) cortical DWI lesions were caused by sacrifices of a small branch of the recipient MCA.
  
  
  CONCLUSIONS
  This study is the first postoperative 3.0-T DWI study of CRS and related clinical events. The incidence of symptomatic postoperative DWI abnormalities was restricted to 1 moyamoya patient representing 5.0% of total patients and 3.0% anastomoses. Although some postoperative DWI abnormalities occurred, CRS was found to be safe with a low risk of symptomatic ischemia.
authors.affiliation: Department of Neurosurgery, Nippon Medical School, Tokyo, Japan. ymurai@nms.ac.jp
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Murai
authors.forename: Takayuki
authors.initials: T
authors.lastname: Mizunari
authors.forename: Ryo
authors.initials: R
authors.lastname: Takagi
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Amano
authors.forename: Sunao
authors.initials: S
authors.lastname: Mizumura
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Komaba
authors.forename: Seiji
authors.initials: S
authors.lastname: Okubo
authors.forename: Shiro
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Akira
authors.initials: A
authors.lastname: Teramoto
mesh_terms: D000086:Acetazolamide; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000473:pathology* / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology; D038524:Diffusion Magnetic Resonance Imaging; D004232:Diuretics; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D009072:Moyamoya Disease / Q000601:surgery; D012189:Retrospective Studies; D013699:Temporal Arteries / Q000601:surgery
chemical_list: D004232:Diuretics; D000086:Acetazolamide