title: Disruption of Cortical Arterial Network is Associated with the Severity of Transient Neurologic Events After Direct Bypass Surgery in Adult Moyamoya Disease.
abstract: OBJECTIVE
  Transient neurologic events (TNEs) frequently occur after revascularization in adult moyamoya disease (MMD). In the present study, we hypothesized that cortical arterial network disruption may be associated with TNE severity after bypass surgery.
  
  
  METHODS
  This retrospective study included 76 hemispheres in 45 consecutive adult patients with MMD who underwent direct revascularization surgery at our institution. We classified cortical arterial network disruption grade (NDG) into the following 4 categories based on angiography: NDG 0, >90% of suprasylvian cortical branches of the middle cerebral artery showed anterograde filling; NDG 1, 50%-90%; NDG 2, <50%; and NDG 3, none. TNE severity was assigned 1 of 4 grades based on symptom duration and clinical features: grade 0, none; grade 1, mild; grade 2, moderate; and grade 3, severe. We evaluated multiple clinical characteristics, including NDG, to identify factors that have a significant association with TNE severity.
  
  
  RESULTS
  Of the 73 hemispheres without perioperative ischemic or hemorrhagic complications, the following degrees of TNEs were developed: grade 0, 33%; grade 1, 30%; grade 2, 22%; and grade 3, 15%. We determined that NDG and left-side surgery were significantly associated with TNE severity (P < 0.01 and P = 0.04, respectively). The NDG had excellent interobserver reliability (weighted κ value = 0.96). There were no significant correlations between TNE severity and other clinical backgrounds.
  
  
  CONCLUSIONS
  NDG is useful for the prediction of severity of TNEs after revascularization. Disturbed bypass flow spreading may lead to the development of TNEs in adult MMD.
authors.affiliation: Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan. Electronic address: egashi@gifu-u.ac.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Egashira
authors.affiliation: Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Yamauchi
authors.affiliation: Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Enomoto
authors.affiliation: Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Nakayama
authors.affiliation: Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yoshimura
authors.affiliation: Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Iwama
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002533:Cerebral Angiography / Q000639:trends; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D002540:Cerebral Cortex / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D002548:Cerebral Revascularization / Q000009:adverse effects* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D009422:Nervous System Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Bypass surgery; Cortical arterial network; Moyamoya disease; Transient neurologic event