Effect of cerebral oxygen saturation monitoring in patients undergoing superficial temporal anterior-middle cerebral artery anastomosis for ischemic Moyamoya disease: a prospective cohort study

OBJECTIVE: Regional cerebral oxygen saturation (rSO(2)) is linked with blood pressure. This study evaluated the influence of perioperative rSO(2) monitoring on the prognosis of ischemic Moyamoya disease (MMD) patients undergoing anastomosis surgery. METHODS: In this prospective cohort, patients with unilateral ischemic MMD of Suzuki stage ≥3 were included. The decision of rSO(2) was made by the clinician and the patient. The rSO(2) group maintained intraoperative rSO(2) levels through the modulation of blood pressure, inhaled oxygen concentration, carbon dioxide in arterial blood, and red blood cell transfusion. The non-rSO(2) group used conventional anesthesia practices. Perioperative mean arterial pressure (MAP), rSO(2) values, neurological complications, and postoperative results were assessed. RESULTS: A total of 75 eligible patients were categorized into a rSO(2) monitoring group (n = 30) and a non-rSO(2) monitoring group (n = 45). For the rSO(2) group, the preoperative rSO(2) was significantly lower on the affected side (P < 0.05). After anastomosis, this value notably increased (P = 0.01). A moderate relationship was observed between perioperative rSO(2) and MAP before, during, and after surgery, with correlation coefficients (r) of 0.536, 0.502, and 0.592 (P < 0.05). Post-surgery MAP levels differed between the groups, with the rSO(2) group showing decreased levels compared to pre-surgery and the non-rOS(2) group displaying elevated levels. Notably, the rSO(2) group reported shorter hospitalizations and decreased neurological complications. Patients with a hypertension history found postoperative MAP influencing hospital stay duration. CONCLUSION: Perioperative rSO(2) surveillance enhanced cerebral perfusion and minimized postoperative complications in ischemic MMD patients. Thus, rSO(2) monitoring is advocated for MMD patients undergoing vascular anastomosis.