Postoperative hemorrhage during the acute phase after direct or combined revascularization for moyamoya disease: risk factors, prognosis and literature review
作者单位：Department of NeurosurgeryBeijing Tiantan HospitalCapital Medical University
会议名称：《第十四届中国医师协会神经外科医师年会》
会议日期：2019年
学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学]
关 键 词：Moyamoya disease Postoperative hemorrhage Cerebral hyperperfusion syndrome Direct revascularization
摘 要：Postoperative hemorrhage during the acute phase is rarely observed after the revascularization surgery for moyamoya disease（MMD） but have severe complications. Its risk factors and outcomes are still unclear. The aim of this study was to investigate the predictors of postoperative hemorrhage during the acute phase in MMD and examine the outcomes of the hemorrhage. Methods: The authors reviewed the preoperative clinical characteristics and radiographic features of 465 consecutive MMD cases（518 procedures） who underwent direct or combined bypass surgery in our institution between 2009 and 2015. Patients with postoperative intracerebral hemorrhage（ICH） or ICH + intraventricular hemorrhage（IVH） during the acute phase were screened, then the incidence, hemorrhage locations and risk factors of these patients were analyzed. Short-term and long-term outcomes（modified Rankin Scale [mRS]） for these patients were also collected. Outcomes were compared between patients who had postoperative ICH and those without postoperative ICH, using propensity-score analysis to reduce the between-group differences in the baseline characteristics. Results: Postoperative hemorrhage occurred in 11 cases from the 518 procedures（2.1%;mean age, 39.82±8.8 years;ICH=9, IVH=2）. 8 cases（72.7%） occurred hemorrhage in the first 24 hours after the operation. In the ICH group, most of the hemorrhage sites（77.8%） were located beneath the anastomosed area, and the mean hematoma volume was 16.98±22.45 ml（range 3-57 ml）. 1 case from the ICH group required hematoma evacuation. For the adult patients（463 procedures, 89.4%）, preoperative hypertension（P=0.005）, computed tomography perfusion（CTP） stageⅢ（P=0.043） and posterior circulation involvement（P=0.027） were significantly associated with postoperative ICH. No significant differences were detected between the postoperative ICH group and the no-hemorrhage group in postoperative neurofunctional status at discharge（P=0.569） and at the last follow-up（P=1.000）. T