Intraoperative transit-time ultrasonography combined with FLOW800 predicts the occurrence of cerebral hyperperfusion syn
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ORIGINAL ARTICLE - VASCULAR NEUROSURGERY - OTHER
Intraoperative transit-time ultrasonography combined with FLOW800 predicts the occurrence of cerebral hyperperfusion syndrome after direct revascularization of Moyamoya disease: a preliminary study Dongxu Yang 1,2 & Xiaohong Zhang 3 & Cunxin Tan 4 & Zhiguang Han 1 & Yutao Su 1 & Ran Duan 4 & Guangchao Shi 4 & Junshi Shao 1 & Penghui Cao 1 & Shihao He 1 & Rong Wang 1,4 Received: 16 August 2020 / Accepted: 27 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Cerebral hyperperfusion syndrome (CHS) is a common complication after direct bypass surgery in patients with Moyamoya disease (MMD). Since preventive measures may be inadequate, we assessed whether the blood flow difference between the superficial temporal artery (STA) and recipient vessels (△BF) and the direct perfusion range (DPR) are related to CHS. Methods We measured blood flow in the STA and recipient blood vessels before bypass surgery by transit-time probe to calculate △BF. Perfusion changes around the anastomosis before and after bypass were analyzed with FLOW800 to obtain DPR. Multiple factors, such as △BF, DPR, and postoperative CHS, were analyzed using binary logistic regression. Results Forty-one patients with MMD who underwent direct bypass surgery were included in the study. Postoperative CHS symptoms occurred in 13/41 patients. △BF and DPR significantly differed between the CHS and non-CHS groups. The optimal receiver operating characteristic (ROC) curve cut-off value was 31.4 ml/min for ΔBF, and the area under the ROC curve (AUC) was 0.695 (sensitivity 0.846, specificity 0.500). The optimal cut-off value was 3.5 cm for DPR, and the AUC was 0.702 (sensitivity 0.615, specificity 0.750). Conclusion Postoperative CHS is caused by multiple factors. △BF is a risk factor for CHS while DPR is a protective factor against CHS. Keywords Cerebral hyperperfusion syndrome . Direct perfusion range . FLOW800 . Transit-time probe . Moyamoya disease
Introduction This article is part of the Topical Collection on Vascular Neurosurgery * Rong Wang [email protected] 1
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2
Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
3
Department of Laboratory Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
4
Department of Neurosurgery, Peking University International Hospital, Beijing, China
Moyamoya disease (MMD) is characterized by a progressive intracranial arterial steno-occlusive disease of unknown etiology, especially at the terminal portion of the internal carotid artery, leading to an abnormal vascular network (moyamoya vessels) at the base of the brain, which causes severe hemodynamic impairment [9, 25]. The moyamoya vessels are very fragile and prone to bleeding or ischemia, so MMD typically presents clinically with intracranial h
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