title: Progress on Complications of Direct Bypass for Moyamoya Disease.
abstract: Moyamoya disease (MMD) involves progressive occlusion of the intracranial internal carotid artery resulting in formation of moyamoya-like vessels at the base of the brain. It can be characterized by hemorrhage or ischemia. Direct vascular bypass is the main and most effective treatment of MMD. However, patients with MMD differ from those with normal cerebral vessels. MMD patients have unstable intracranial artery hemodynamics and a poor blood flow reserve; therefore, during the direct bypass of superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis, perioperative risk factors and anesthesia can affect the hemodynamics of these patients. When brain tissue cannot tolerate a high blood flow rate, it becomes prone to hyperperfusion syndrome, which leads to neurological function defects and can even cause intracranial hemorrhage in severe cases. The brain tissue is prone to infarction when hemodynamic equilibrium is affected. In addition, bypass vessels become susceptible to occlusion or atrophy when blood resistance increases. Even compression of the temporalis affects bypass vessels. Because the STA is used in MMD surgery, the scalp becomes ischemic and is likely to develop necrosis and infection. These complications of MMD surgery are difficult to manage and are not well understood. To date, no systematic studies of the complications that occur after direct bypass in MMD have been performed, and reported complications are hidden among various case studies; therefore, this paper presents a review and summary of the literature in PubMed on the complications of direct bypass in MMD.
authors: Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China.
authors: Jinlu
authors: J
authors: Yu
authors: Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China.
authors: Lei
authors: L
authors: Shi
authors: Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China.
authors: Yunbao
authors: Y
authors: Guo
authors: Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China.
authors: Baofeng
authors: B
authors: Xu
authors: Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China.
authors: Kan
authors: K
authors: Xu
mesh_terms: D001921:Brain / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery; D002343:Carotid Artery, Internal / Q000503:physiopathology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000503:physiopathology; D020768:Middle Cerebral Artery / Q000503:physiopathology; D009072:Moyamoya Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D013699:Temporal Arteries / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
keywords: complications; direct bypass; moyamoya disease; progress