Predictors and Clinical Features of Postoperative Hyperperfusion after Surgical Revascularization for Moyamoya Disease
A Serial Single Photon Emission CT/Positron Emission Tomography Study
Background and Purpose—Clinical features and pathophysiology of postoperative hyperperfusion in moyamoya disease are still unclear. This study was aimed to clarify the incidence and time course of postoperative hyperperfusion and to determine the independent predictors of postoperative hyperperfusion in moyamoya disease.
Methods—This prospective study included 41 patients who underwent surgical revascularization for moyamoya disease. Using 15O-gas positron emission tomography, hemodynamic and metabolic parameters were quantified before surgery. Using single photon emission CT, cerebral blood flow was serially measured just after surgery and on 2 and 7 days postsurgery. A multivariate logistic regression analysis was conducted to test the effect of multiple variables on postoperative hyperperfusion.
Results—Postoperative hyperperfusion was observed in 29 (50.0%) of 58 operated hemispheres. The incidence of both radiological and symptomatic hyperperfusion was significantly higher in adult patients than in pediatric ones (P=0.026 and P=0.0037, respectively). Hyperperfusion just after surgery more often led to subsequent neurological deficits (P=0.033). A multivariate analysis revealed that preoperative cerebral blood volume increase was an independent predictor of both radiological and symptomatic hyperperfusion after surgery in adult moyamoya disease (OR, 6.6 and 12.3, respectively).
Conclusions—Postoperative hyperperfusion after surgical revascularization is not rare in moyamoya disease. Adult patients with a cerebral blood volume increase may be at high risk for radiological and symptomatic hyperperfusion after surgery. Careful perioperative management would reduce surgical complications and improve long-term outcome in moyamoya disease.
- Received March 24, 2012.
- Revision received June 23, 2012.
- Accepted June 25, 2012.
- © 2012 American Heart Association, Inc.