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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

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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-duro-myo-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.

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Data availability

The data and materials that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This study was supported by JSPS KAKENHI grant number 17K10815 (Miki Fujimura) and JSPS KAKENHI grant number 20K09362 (Miki Fujimura).

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Authors and Affiliations

  1. Department of Neurosurgery, Kohnan Hospital, Sendai, Japan

    Masahito Katsuki, Miki Fujimura & Taketo Nishizawa

  2. Department of Neurosurgery, Tohoku University, Sendai, Japan

    Masahito Katsuki, Ryosuke Tashiro, Taketo Nishizawa & Teiji Tominaga

  3. Division of Advanced Cerebrovascular Surgery (Kohnan Hospital), Tohoku University Graduate School of Medicine, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, Miyagi, 982-8523, Japan

    Miki Fujimura

  4. Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan

    Yasutake Tomata

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  1. Masahito Katsuki
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Contributions

Conception and design: MK and MF. Data acquisition: MK, TN, RT, and MF. Drafting the article: MK. Statistical analysis: YT. Critical revision and advice: MF. Supervision: TT.

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Correspondence to Miki Fujimura.

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The authors declare that they have no conflicts of interest.

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The ethical committee of Kohnan Hospital approved this study.

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Written informed consent for participation in the study was received from all subjects.

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Written informed consent for publication was received from all subjects.

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Katsuki, M., Fujimura, M., Tashiro, R. et al. 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. Neurosurg Rev 44, 2191–2200 (2021). https://doi.org/10.1007/s10143-020-01395-z

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  • DOI: https://doi.org/10.1007/s10143-020-01395-z

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