title: Venous reddening as a possible sign of hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis for moyamoya disease: case report.
abstract: Here we report a case of moyamoya disease in which cortical veins reddened after superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis, following postoperative hyperperfusion. A 37-year-old man with moyamoya disease suffered cerebral infarction in his right hemisphere. Single photon emission computed tomography (SPECT) showed impaired cerebral blood flow (CBF) in both cerebral hemispheres. The patient underwent STA-MCA anastomosis in the right cerebral hemisphere. During operation, soon after declamping the STA, cortical veins near the anastomosis site changed its color from blue to red. This change was repeatable by clamping and declamping of the STA. Postoperative SPECT and computed tomography (CT) demonstrated increased CBF and subarachnoid hemorrhage at the anastomosis site, suggesting the occurrence of postoperative hyperperfusion. By strictly controlling the patient's blood pressure, the syndrome resolved 1 week after the operation. We propose that the venous reddening after STA-MCA anastomosis may be a sign of postoperative hyperperfusion.
authors.affiliation: Department of Neurosurgery, Chiba Cardiovascular Center.
authors.forename: Toshio
authors.initials: T
authors.lastname: Machida
authors.forename: Junichi
authors.initials: J
authors.lastname: Ono
authors.forename: Ryota
authors.initials: R
authors.lastname: Nomura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fujikawa
authors.forename: Osamu
authors.initials: O
authors.lastname: Nagano
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Higuchi
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D002548:Cerebral Revascularization; D002550:Cerebral Veins / Q000473:pathology*; D003937:Diagnosis, Differential; D006801:Humans; D017495:Hyperpigmentation / Q000175:diagnosis*; D008297:Male; D009072:Moyamoya Disease / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis*; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed