Pre-operative higher hematocrit and lower total protein levels are independent risk factors for cerebral hyperperfusion
- PDF / 3,860,020 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 110 Downloads / 179 Views
ORIGINAL ARTICLE
Pre-operative higher hematocrit and lower total protein levels are independent risk factors for cerebral hyperperfusion syndrome after superficial temporal artery–middle cerebral artery anastomosis with pial synangiosis in adult moyamoya disease patients—case-control study Masahito Katsuki 1,2 & Miki Fujimura 1,3 Teiji Tominaga 2
&
Ryosuke Tashiro 2 & Yasutake Tomata 4 & Taketo Nishizawa 1,2 &
Received: 2 May 2020 / Revised: 18 August 2020 / Accepted: 15 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Superficial temporal artery (STA)–middle cerebral artery (MCA) anastomosis is a standard treatment for adult moyamoya disease (MMD) patients. Cerebral hyperperfusion (CHP) syndrome is one of the most serious complications of this procedure that can result in deleterious outcomes, but predicting CHP before revascularization surgery remains challenging. Furthermore, the hematological/ serological factors associated with CHP syndrome are unknown. To investigate the correlation between pre-operative hematological/serological factors and the development of CHP syndrome after STA-MCA anastomosis with encephalo-duromyo-synangiosis (EDMS) for MMD., a pre-operative peripheral blood test was performed within 5 days before surgery. Local cerebral blood flow (CBF) at the site of anastomosis was quantified by N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography 1 and 7 days after surgery, and the pre-operative CBF value at the corresponding area was measured. We defined CHP syndrome as a local CBF increase over 150% compared with the pre-operative value, which was responsible for delayed intracranial hemorrhage, transient focal neurological deterioration, and/or seizure. Then, we retrospectively investigated the correlation between peripheral blood test results and the development of CHP syndrome. CHP syndrome 1 day after STA-MCA anastomosis with EDMS was observed in nine patients (9/114 hemispheres; 7.9%). Multivariate analysis with multiple imputation revealed that higher hematocrit value and lower total protein level were significantly associated with the development of CHP syndrome (p value: 0.028 and 0.043, respectively). Higher pre-operative hematocrit levels and lower pre-operative total protein levels are novel risk factors for CHP syndrome after direct revascularization surgery in adult MMD patients. Keywords Cerebral blood flow . Cerebral hyperperfusion . Extracranial-intracranial bypass . Hematocrit . Moyamoya disease . Total protein Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10143-020-01395-z) contains supplementary material, which is available to authorized users. * Miki Fujimura [email protected] 1
Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
2
Department of Neurosurgery, Tohoku University, Sendai, Japan
3
Division of Advanced Cerebrovascular Surgery (Kohnan Hospital), Tohoku University Graduate School of Medicine, 4-20-1 Nagamachi-minami, Taihaku-ku,
Data Loading...
