title: Indocyanine green videoangiography for assessment of postoperative hyperperfusion in moyamoya disease.
abstract: BACKGROUND
  Postoperative cerebral hyperperfusion (HP) is a notable complication that occurs more frequently in moyamoya disease (MMD) than in atherosclerosis. This study aimed to clarify the characteristics of intraoperative indocyanine green (ICG) videoangiography in MMD and atherosclerotic disease in terms of postoperative HP.
  
  
  METHODS
  This prospective study included 47 patients with 60 sides that underwent superior temporal artery (STA)-middle cerebral artery (MCA) single bypass. ICG videoangiography was performed after revascularization. The ICG time intensity curve was recorded in the STA, proximal MCA, distal MCA, and superficial Sylvian vein, and the angiographic differences among adult MMD, pediatric MMD, and atherosclerosis were analyzed.
  
  
  RESULTS
  Twenty-two patients (27 sides) had adult MMD, 14 patients (22 sides) had pediatric MMD, and 11 patients (11 sides) had atherosclerosis. Postoperative HP was significantly higher in adult MMD (40.7 %) than in pediatric MMD (18.2 %) and atherosclerosis (0 %). Adult MMD with HP was associated with a longer ICG peak time (P < 0.001). There was no correlation between the ICG peak time and preoperative cerebral blood flow or vascular reserve. The ratio of the vessel caliber was also higher in adult MMD with HP (P < 0.001).
  
  
  CONCLUSIONS
  ICG videoangiography provides different characteristics of bypass flow among adult MMD, pediatric MMD, and atherosclerosis. Poor run-off and stagnation of blood flow from the STA might contribute to postoperative HP in MMD. The occurrence of postoperative HP in MMD could depend on two factors: donor STA size and poor run-off and integrity of the blood brain barrier in the recipient MCA.
authors.affiliation: Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan, nobstanford@gmail.com.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Horie
authors.forename: Yuhtaka
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Izumo
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Suyama
authors.forename: Izumi
authors.initials: I
authors.lastname: Nagata
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002533:Cerebral Angiography / Q000379:methods*; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D004396:Coloring Agents; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007208:Indocyanine Green; D002537:Intracranial Arteriosclerosis / Q000601:surgery*; D007431:Intraoperative Complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D009072:Moyamoya Disease / Q000601:surgery*; D011446:Prospective Studies; D013699:Temporal Arteries / Q000601:surgery; D014741:Video Recording / Q000379:methods; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green