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Prognostic factors associated with perioperative ischemic complications in adult-onset moyamoya disease

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Abstract

Background

To clarify the risk factors associated with perioperative ischemic complications in adult-onset moyamoya disease.

Material and methods

The incidence and causes of perioperative ischemic complications in adult-onset moyamoya disease were retrospectively examined by reviewing 165 surgically treated adult patients. Two hundred forty-six revascularization procedures were performed in these patients.

Results

There were 19 (7.7%) perioperative ischemic complications (four infarctions with neurological sequelae and 15 reversible ischemic neurological deficits with a new lesion). The complications occurred in the initially affected hemispheres in 17 (89.4%) of the 19 ischemic complications, regardless of the side of the operation. Multiple ischemic episodes (defined as over four-symptom episodes before treatment), the presence of a preoperative low density area (LDA) on computed tomographic (CT) scanning, and a high signal intensity on diffusion-weighted magnetic resonance (MR) imaging were significantly correlated with perioperative ischemic complications (p < 0.05, p < 0.05, and p < 0.01, respectively). Non-surgical hemodynamic risk factors, i.e., hypercapnia, hypocapnia, or hypotension/hypovolemia, were noted in all of the 19 cases. None of the surgical factors evaluated were associated with the complications identified.

Conclusions

Avoidance of non-surgical hemodynamic risk factors as well as maintaining vital collateral vessels is essential for the prevention of perioperative hemodynamic brain damage in patients with adult-onset moyamoya disease. In addition, very close monitoring of the perioperative care of patients with preoperative multiple ischemic episodes and an LDA or high signal intensity on preoperative CT or diffusion-weighted MR imaging is extremely important.

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None of the authors have any financial interest in the subject under discussion in this paper.

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Authors and Affiliations

  1. Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Seung-Jae Hyun

  2. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea

    Jong-Soo Kim & Seung-Chyul Hong

Authors
  1. Seung-Jae Hyun
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  2. Jong-Soo Kim
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  3. Seung-Chyul Hong
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Corresponding author

Correspondence to Seung-Chyul Hong.

Additional information

The authors retrospectively analyzed perioperative ischemic complications in adult-onset moyamoya disease. They showed 19 (7.7%) of 165 surgically treated adult patients who showed ischemic complications between 0 and 20 days after surgery. It is interesting and important to know that even after the indirect revascularization, ischemic complications occurred. As the authors mentioned, close observation of the patients with preoperative multiple ischemic episodes is important.

Kazuhiro Hongo, M.D.

Matsumoto, Japan

The submitted manuscript does not contain information about medical devices or drugs.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Hyun, SJ., Kim, JS. & Hong, SC. Prognostic factors associated with perioperative ischemic complications in adult-onset moyamoya disease. Acta Neurochir 152, 1181–1188 (2010). https://doi.org/10.1007/s00701-010-0638-1

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  • DOI: https://doi.org/10.1007/s00701-010-0638-1

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