title: Intraoperative assessment of cortical perfusion by indocyanine green videoangiography in surgical revascularization for moyamoya disease.
abstract: BACKGROUND
  Postoperative hyperperfusion is a potential complication of the direct bypass procedure for moyamoya disease (MMD). However, no reliable modality is available yet for the prediction of postoperative hyperperfusion during surgery for MMD. This study aimed to investigate whether semiquantitative analysis of indocyanine green (ICG) videoangiography could contribute to the prediction of postoperative hyperperfusion in MMD.
  
  
  METHODS
  This study included 12 hemispheres from 10 patients who underwent surgical revascularization for MMD. Intraoperative ICG videoangiography was performed before and after a direct bypass procedure. The ICG intensity-time curves were semiquantitatively analyzed to evaluate cortical perfusion by calculating the blood flow index (BFI). Using single-photon emission computed tomography (SPECT), postoperative cerebral blood flow measurements were performed thrice: immediately, and 2 and 7 days after surgery.
  
  
  RESULTS
  BFI significantly increased from 21.3 ± 10.5 to 38.4 ± 20.0 after bypass procedures in all the hemispheres (p < 0.01). The ratio of BFI before and after the bypass procedure was 2.4 ± 2.0, ranging from 0.5 to 8.0. Postoperative hyperperfusion was observed in nine of the 12 operated hemispheres within 7 days after surgery. Of these, three hemispheres developed hyperperfusion immediately after surgery. In the adult cases, the increase in the ratio of BFI after bypass was significantly greater in those who developed hyperperfusion immediately after surgery than in those who did not (6.5 ± 0.5 vs. 1.8 ± 2.1, p < 0.01). In contrast, no significant increase in BFI was observed in the pediatric MMD patients who experienced immediate hyperperfusion. No correlation between the changes in BFI and the occurrence of delayed hyperperfusion was observed.
  
  
  CONCLUSIONS
  Our results suggest that semiquantitative analysis of BFI by intraoperative ICG videoangiography is useful in evaluating changes in cortical perfusion after bypass procedures for MMD and can predict the occurrence of early-onset hyperperfusion in MMD patients after direct bypass.
authors: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo, 060-8638, Japan, uchinoh@hotmail.co.jp.
authors: Haruto
authors: H
authors: Uchino
authors: Ken
authors: K
authors: Kazumata
authors: Masaki
authors: M
authors: Ito
authors: Naoki
authors: N
authors: Nakayama
authors: Satoshi
authors: S
authors: Kuroda
authors: Kiyohiro
authors: K
authors: Houkin
mesh_terms: D000293:Adolescent; D000328:Adult; D002545:Brain Ischemia / Q000175:diagnosis* / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D002648:Child; D002675:Child, Preschool; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007208:Indocyanine Green; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000175:diagnosis* / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D012039:Regional Blood Flow / Q000502:physiology; D015899:Tomography, Emission-Computed, Single-Photon; D014741:Video Recording
chemical_list: D007208:Indocyanine Green