Skip to main content
SpringerLink
Log in

Usefulness of intraoperative laser Doppler flowmetry and thermography to predict a risk of postoperative hyperperfusion after superficial temporal artery–middle cerebral artery bypass for moyamoya disease

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

We investigated whether postoperative hyperperfusion in moyamoya disease can be predicted using intraoperative laser Doppler flowmetry and/or thermography. A prospective study was conducted on 27 patients (39 hemispheres) with moyamoya disease who underwent superficial temporal artery–middle cerebral artery (STA–MCA) bypass. During surgery, regional cerebral blood flow (rCBF) was measured with a laser Doppler flowmeter and the temperature of the cortical surface was measured with an infrared thermograph. Postoperative hyperperfusion was assessed immediately after surgery based on CBF study under sedation (propofol) as >100% increase in corrected rCBF compared to preoperative values. Postoperative hyperperfusion on CBF was observed in two patients (7.4%). A significant correlation was observed between intraoperative rCBF changes and postoperative rCBF increase (Pearson’s method: r = 0.555, p = 0.0003; simple regression: Y = 1.22X + 3.289, r 2 = 0.308, p = 0.0004). Furthermore, the rCBF changes measured by laser Doppler flowmetry were significantly greater in patients with postoperative hyperperfusion (p = 0.0193) and CHS (p = 0.0193). The present study suggests that intraoperative rCBF measurement using laser Doppler flowmetry may predict a risk of post-EC–IC bypass cerebral hyperperfusion in moyamoya disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Amin-Hanjani S, Du X, Mlinarevich N, Meglio G, Zhao M, Charbel FT (2005) The cut flow index: an intraoperative predictor of the success of extracranial–intracranial bypass for occlusive cerebrovascular disease. Neurosurgery 56(1 Suppl):75–85

    Article  PubMed  Google Scholar 

  2. Fujimoto S, Toyoda K, Inoue T, Hirai Y, Uwatoko T, Kishikawa K, Yasumori K, Ibayashi S, Iida FM, Okada Y (2004) Diagnostic impact of transcranial color-coded real-time sonography with echo contrast agents for hyperperfusion syndrome after carotid endarterectomy. Stroke 35:1852–1856

    Article  PubMed  Google Scholar 

  3. Fujimura M, Mugikura S, Kaneta T, Shimizu H, Tominaga T (2009) Incidence and risk factors for symptomatic cerebral hyperperfusion after superficial temporal artery–middle cerebral artery anastomosis in patients with moyamoya disease. Surg Neurol 71:442–447

    Article  PubMed  Google Scholar 

  4. Fujimura M, Shimizu H, Mugikura S, Tominaga T (2009) Delayed intracerebral hemorrhage after superficial temporal artery–middle cerebral artery anastomosis in a patient with moyamoya disease: possible involvement of cerebral hyperperfusion and increased vascular permeability. Surg Neurol 71:223–227

    Article  PubMed  Google Scholar 

  5. Horowitz M, Yonas H, Albright AL (1995) Evaluation of cerebral blood flow and hemodynamic reserve in symptomatic moyamoya disease using stable Xenon-CT blood flow. Surg Neurol 44:251–262

    Article  PubMed  CAS  Google Scholar 

  6. Hoshino T, Katayama Y, Sakatani K, Kano T, Murata Y (2006) Intraoperative monitoring of cerebral blood oxygenation and hemodynamics during extracranial–intracranial bypass surgery by a newly developed visible light spectroscopy system. Surg Neurol 65:569–576

    Article  PubMed  Google Scholar 

  7. Hosoda K, Kawaguchi T, Shibata Y, Kamei M, Kidoguchi K, Koyama J, Fujita S, Tamaki N (2001) Cerebral vasoreactivity and internal carotid artery flow help to identify patients at risk for hyperperfusion after carotid endarterectomy. Stroke 32:1567–1573

    PubMed  CAS  Google Scholar 

  8. Jorgensen L, Schroeder T (1993) Defective cerebrovascular autoregulation after carotid endarterectomy. Eur J Vasc Surg 7:370–379

    Article  PubMed  CAS  Google Scholar 

  9. Kaisti K, Metsahonkala L, Teras M, Oikonen V, Aalto S, Jaaskelainen S, Hinkka S, Scheinin H (2002) Effects of surgical levels of propofol and sevoflurane anesthesia on cerebral blood flow in healthy subjects studied with positron emission tomography. Anesthesiology 96:1358–1370

    Article  PubMed  CAS  Google Scholar 

  10. Kawamata T, Okada Y, Kawashima A, Yoneyama T, Yamaguchi K, Ono Y, Hori T (2009) Post-carotid endarterectomy cerebral hyperperfusion can be prevented by minimizing intraoperative cerebral ischemia and strict postoperative blood pressure control under continuous sedation. Neurosurgery 64:447–454

    Article  PubMed  Google Scholar 

  11. Kimme P, Ledin T, Sjoberg F (2007) Dose effect of sevoflurane and isoflurane anesthetics on cortical blood flow during controlled hypotension in the pig. Acta Anaesthesiol Scand 51:607–613

    Article  PubMed  CAS  Google Scholar 

  12. Koga H, Mori K, Ono H, Kuwahara M, Matsuse E (1987) Intraoperative regional thermography during surgery for brain tumor. Neurol Med Chir (Tokyo) 27:1033–1038

    Article  CAS  Google Scholar 

  13. Komoribayashi N, Ogasawara K, Kobayashi M, Saitoh H, Terasaki K, Inoue T, Ogawa A (2006) Cerebral hyperperfusion after carotid endarterectomy is associated with preoperative hemodynamic impairment and intraoperative cerebral ischemia. J Cereb Blood Flow Metab 26:878–884

    Article  PubMed  Google Scholar 

  14. Kondo S, Okada Y, Iseki H, Hori T, Takakura K, Kobayashi A, Nagata H (2000) Thermological study of drilling bone tissue with a high-speed drill. Neurosurgery 46:1162–1168

    Article  PubMed  CAS  Google Scholar 

  15. Nambu K, Suzuki R, Hirakawa K (1995) Cerebral blood flow: measurement with xenon-enhanced dynamic helical CT. Radiology 195:53–57

    PubMed  CAS  Google Scholar 

  16. Nussbaum ES, Erickson DL (2000) Extracranial–intracranial bypass for ischemic cerebrovascular disease refractory to maximal medical therapy. Neurosurgery 46:37–43

    Article  PubMed  CAS  Google Scholar 

  17. Ogasawara K, Komoribayashi N, Kobayashi M, Fukuda T, Inoue T, Yamadate K, Ogawa (2005) A neural damage caused by cerebral hyperperfusion after arterial bypass surgery in a patient with moyamoya disease:case report. Neurosurgery 56:E1380

    Article  PubMed  Google Scholar 

  18. Ogasawara K, Yukawa H, Kobayashi M, Mikami C, Konno H, Terasaki K, Inoue T, Ogawa A (2003) Prediction and monitoring of cerebral hyperperfusion after carotid endarterectomy by using single-photon emission computerized tomography scanning. J Neurosurg 99:504–510

    Article  PubMed  Google Scholar 

  19. Ohue S, Kumon Y, Kohno K, Watanabe H, Iwata S, Ohnishi T (2008) Postoperative temporary neurological deficits in adults with moyamoya disease. Surg Neurol 69:281–287

    Article  PubMed  Google Scholar 

  20. Okada Y, Kawamata T, Kawashima A, Hori T (2007) Intraoperative application of thermography in extracranial-intracranial bypass. Neurosurgery 60(4 Suppl 2):362–365

    PubMed  Google Scholar 

  21. Okada Y, Shima T, Nishida M, Yamane K, Yamada T, Yamanaka C (1998) Effectiveness of superficial temporal artery–middle cerebral artery anastomosis in adult moyamoya disease: cerebral hemodynamics and clinical course in ischemic and hemorrhagic varieties. Stroke 29:625–630

    PubMed  CAS  Google Scholar 

  22. Okada Y, Shima T, Yamane K, Yamanaka C, Kagawa R (1999) Cylindrical or T-shaped silicone rubber stents for microanastomosis —technical note. Neurol Med Chir (Tokyo) 39:55–58

    Article  CAS  Google Scholar 

  23. Okudera H, Kobayashi S, Toriyama T (1994) Intraoperative regional and functional thermography during resection of cerebral arteriovenous malformation. Neurosurgery 34:1065–1067

    Article  PubMed  CAS  Google Scholar 

  24. Oshima T, Karasawa F, Satoh T (2002) Effects of propofol on cerebral blood flow and the metabolic rate of oxygen in humans. Acta Anaesthesiol Scand 46:831–835

    Article  PubMed  CAS  Google Scholar 

  25. Ouchi T, Ochiai R, Takeda J, Tsukada H, Kakiuchi T (2006) Combined effects of propofol and mild hypothermia on cerebral metabolism and blood flow in rhesus monkey: a positron emission tomography study. J Anesth 20:208–214

    Article  PubMed  Google Scholar 

  26. Piepgras D, Morgan M, Sundt TJ, Yanagihara T, Mussman L (1988) Intracerebral hemorrhage after carotid endarterectomy. J Neurosurg 68:532–536

    Article  PubMed  CAS  Google Scholar 

  27. Pinaud M, Lelausque J, Chetanneau A, Fauchoux N, Menegalli D, Souron R (1990) Effects of propofol on cerebral hemodynamics and metabolism in patients with brain trauma. Anesthesiology 73:404–409

    Article  PubMed  CAS  Google Scholar 

  28. Sundt TJ, Sharbrough F, Piepgras D, Kearns T, Messick JJ, O'Fallon W (1981) Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy: with results of surgery and hemodynamics of cerebral ischemia. Mayo Clin Proc 56:533–543

    PubMed  Google Scholar 

  29. The EC/IC Bypass Study Group (1985) Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 313:1191–1200

    Article  Google Scholar 

  30. Uno M, Nakajima N, Nishi K, Shinno K, Nagahiro S (1998) Hyperperfusion syndrome after extracranial–intracranial bypass in a patient with moyamoya disease. Case report. Neuro Med Chir (Tokyo) 38:420–424

    Article  CAS  Google Scholar 

  31. van Mook W, Rennenberg R, Schurink G, van Oostenbrugge R, Mess W, Hofman P, de Leeuw P (2005) Cerebral hyperperfusion syndrome. Lancet Neurol 4:877–888

    Article  PubMed  Google Scholar 

  32. Vandesteene A, Trempont V, Engelman E, Deloof T, Focroul M, Schoutens A, de Rood M (1988) Effect of propofol on cerebral blood flow and metabolism in man. Anaesthesia 43(Suppl):42–43

    Article  PubMed  CAS  Google Scholar 

  33. Woitzik J, Horn P, Vajkoczy P, Schmiedek P (2005) Intraoperative control of extracranial–intracranial bypass patency by near-infrared indocyanine green videoangiography. J Neurosurg 102:692–698

    Article  PubMed  Google Scholar 

  34. Yamaguchi K, Kawamata T, Kawashima A, Hori T, Okada Y (2010) Incidence and predictive factors of cerebral hyperperfusion after extracranial–intracranial bypass for occlusive cerebrovascular diseases. Neurosurgery 67:1548–1554

    Article  PubMed  Google Scholar 

  35. Yonas H, Wolfson SK Jr, Gur D, Latchaw RE, Good WF, Leanza R, Jackson DL, Jannetta PJ, Reinmuth OM (1984) Clinical experience with the use of xenon-enhanced CT blood flow mapping in cerebral vascular disease. Stroke 15:443–450

    PubMed  CAS  Google Scholar 

Download references

Acknowledgement

This study was supported by research funds of Department of Neurosurgery, Tokyo Women’s Medical University.

Disclosure

The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article

Conflict of Interest

All authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. Departments of Neurosurgery, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, 162-8666, Tokyo, Japan

    Takakazu Kawamata, Akitsugu Kawashima, Kohji Yamaguchi, Tomokatsu Hori & Yoshikazu Okada

Authors
  1. Takakazu Kawamata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akitsugu Kawashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kohji Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tomokatsu Hori
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshikazu Okada
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takakazu Kawamata.

Additional information

Comments

Yasuhiro Yonekawa, Zurich, Switzerland

Kawamata et al. have shown an elegant method to predict a risk of postoperative hyperperfusion after STA-MCA bypassfor Moyamoya disease by using laser Dopplerflowmetryintraoperatively at the time of EC-IC bypass surgery, what could be confirmed by postoperative Xe-CT scan-|rCBF measurement. This simple method would contribute to the management of postoperative hyperperfusion, although its occurrence has been reported to be rather infrequent but can be associated with considerable sequelae.

By the way, it was my little surprise that intraoperative thermography change did not correlate with postoperative rCBF change. This might be due to inherent methodological problems namelythis can be delicately influenced byroom temperature and/or heat produced by the light of operating microscope. I would be interested for the purpose to use the Peltier stack which would have less above mentioned problems and its usefulnessfulness was very impressive at the time of parent artery temporary occlusionalong with simplicity of its handling in aneurysm surgery (1).

References

1. Ogata N, Fournier JY, Imhof HG, Yonekawa Y: Thermal diffusion blood flow monitoring during aneurysm surgery. ActaNeurochir (Wien) 138: 726–731, 1996

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kawamata, T., Kawashima, A., Yamaguchi, K. et al. Usefulness of intraoperative laser Doppler flowmetry and thermography to predict a risk of postoperative hyperperfusion after superficial temporal artery–middle cerebral artery bypass for moyamoya disease. Neurosurg Rev 34, 355–362 (2011). https://doi.org/10.1007/s10143-011-0331-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-011-0331-8

Keywords

Search

Navigation