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Significance of a new hemodynamic classification of recipient vessels in predicting postoperative hyperperfusion during STA-MCA bypass for adult patients with moyamoya disease

Significance of a new hemodynamic classification of recipien...

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第十四届中国医师协会神经外科医师年会

作者： Jianjian Zhang Jincao Chen

BACKGROUND: Postoperative cerebral hyperperfusion（CHP） could cause severe complications after superficial temporal artery-middle cerebral artery（STA-MCA） bypass surgery for adult patients with moyamoya disease（MMD）. OBJECTIVE: We aim to predict the occurrence of CHP through a new classification by the hemodynamic sources of the parasylvian cortical arteries（PSCAs） which is commonly selected as the recipient vessels. METHODS: We retrospectively collected data of consecutive adult MMD patients that underwent combined revascularization. The PSCAs were classified as M-PSCA, A-PSCA, CA-PSCA, P-PSCA and E-PSCA based on their hemodynamic sources from MCA, anterior cerebral artery（ACA）, contralateral ACA, posterior cerebral artery（PCA） and extracranial artery（ECA）, respectively. Their distributional characteristics were studied. The patients’ demographics, incidence of postoperative CHP, and post-/pre-operative relative cerebral blood flow（rCBF） values were analyzed. RESULTS: A total 68 patients（75 hemispheres） were identified. The total incidence of postoperative focal CHP was 42.7%（32/75）. The M-PSCA group had a significant higher risk of focal（26/45, 57.8%） and symptomatic CHP（12/45, 26.7%） than the non-M-PSCA group（focal, 6/30, 20%;symptomatic, 2/30, 6.7%, both P ＜.05）. The post-/pre-operative rCBF values of the M-PSCA group were significantly higher than the non-M-PSCA group（P ＜.001）. 12（85.7%） in the 14 symptomatic CHPs and all the 4（100%） postoperative hemorrhages were from the M-PSCA group. CONCLUSIONS: Preoperative classification of PSCAs is recommended in the surgical procedure of STA-MCA anastomoses for adult MMD patients, which may help to predict the occurrence of postoperative CHP.

关键词： moyamoya disease cerebral hyperperfusion cerebral blood flow hemodynamics bypass surgery

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