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Symptomatic hyperperfusion after combined revascularization surgery in patients with pediatric moyamoya disease: patient series

BACKGROUND: Symptomatic hyperperfusion after cerebral revascularization for pediatric moyamoya disease (MMD) is a rare phenomenon. The authors report a series of patients with this condition. OBSERVATIONS: In all three patients in this case series, the combined revascularization was on the left side...

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Autores principales: Araki, Yoshio, Mamiya, Takashi, Fujita, Naotoshi, Yokoyama, Kinya, Uda, Kenji, Kanamori, Fumiaki, Takayanagi, Kai, Ishii, Kazuki, Nishihori, Masahiro, Takeuchi, Kazuhito, Tanahashi, Kuniaki, Nagata, Yuichi, Nishimura, Yusuke, Tanei, Takafumi, Muraoka, Shinsuke, Izumi, Takashi, Kato, Katsuhiko, Saito, Ryuta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Association of Neurological Surgeons 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379730/
http://dx.doi.org/10.3171/CASE2274
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author Araki, Yoshio
Mamiya, Takashi
Fujita, Naotoshi
Yokoyama, Kinya
Uda, Kenji
Kanamori, Fumiaki
Takayanagi, Kai
Ishii, Kazuki
Nishihori, Masahiro
Takeuchi, Kazuhito
Tanahashi, Kuniaki
Nagata, Yuichi
Nishimura, Yusuke
Tanei, Takafumi
Muraoka, Shinsuke
Izumi, Takashi
Kato, Katsuhiko
Saito, Ryuta
author_facet Araki, Yoshio
Mamiya, Takashi
Fujita, Naotoshi
Yokoyama, Kinya
Uda, Kenji
Kanamori, Fumiaki
Takayanagi, Kai
Ishii, Kazuki
Nishihori, Masahiro
Takeuchi, Kazuhito
Tanahashi, Kuniaki
Nagata, Yuichi
Nishimura, Yusuke
Tanei, Takafumi
Muraoka, Shinsuke
Izumi, Takashi
Kato, Katsuhiko
Saito, Ryuta
author_sort Araki, Yoshio
collection PubMed
description BACKGROUND: Symptomatic hyperperfusion after cerebral revascularization for pediatric moyamoya disease (MMD) is a rare phenomenon. The authors report a series of patients with this condition. OBSERVATIONS: In all three patients in this case series, the combined revascularization was on the left side, the patency of bypass grafts was confirmed after surgery, and focal hyperemia around the anastomotic site was observed on single photon emission computed tomography (SPECT). On the first to eighth days after surgery, all of the patients developed neurological manifestations, including motor aphasia, cheiro-oral syndrome, motor weakness of their right upper limbs, and severe headaches. These symptoms disappeared completely approximately 2 weeks after surgery, and all patients were discharged from the hospital. Quantitative SPECT was performed to determine the proportional change in cerebral blood flow (ΔRCBF) (to ipsilateral cerebellar ratio (denoted ΔRCBF) in the region of interest around the anastomoses, and the mean value was 1.34 (range, 1.29–1.41). LESSONS: This rare condition, which develops soon after surgery, requires an accurate diagnosis by SPECT. One indicator is that the ΔRCBF has risen to 1.3 or higher. Subsequently, strategic blood pressure treatment and fluid management could prevent the development of hemorrhagic stroke.
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spelling pubmed-93797302022-10-04 Symptomatic hyperperfusion after combined revascularization surgery in patients with pediatric moyamoya disease: patient series Araki, Yoshio Mamiya, Takashi Fujita, Naotoshi Yokoyama, Kinya Uda, Kenji Kanamori, Fumiaki Takayanagi, Kai Ishii, Kazuki Nishihori, Masahiro Takeuchi, Kazuhito Tanahashi, Kuniaki Nagata, Yuichi Nishimura, Yusuke Tanei, Takafumi Muraoka, Shinsuke Izumi, Takashi Kato, Katsuhiko Saito, Ryuta J Neurosurg Case Lessons Case Lesson BACKGROUND: Symptomatic hyperperfusion after cerebral revascularization for pediatric moyamoya disease (MMD) is a rare phenomenon. The authors report a series of patients with this condition. OBSERVATIONS: In all three patients in this case series, the combined revascularization was on the left side, the patency of bypass grafts was confirmed after surgery, and focal hyperemia around the anastomotic site was observed on single photon emission computed tomography (SPECT). On the first to eighth days after surgery, all of the patients developed neurological manifestations, including motor aphasia, cheiro-oral syndrome, motor weakness of their right upper limbs, and severe headaches. These symptoms disappeared completely approximately 2 weeks after surgery, and all patients were discharged from the hospital. Quantitative SPECT was performed to determine the proportional change in cerebral blood flow (ΔRCBF) (to ipsilateral cerebellar ratio (denoted ΔRCBF) in the region of interest around the anastomoses, and the mean value was 1.34 (range, 1.29–1.41). LESSONS: This rare condition, which develops soon after surgery, requires an accurate diagnosis by SPECT. One indicator is that the ΔRCBF has risen to 1.3 or higher. Subsequently, strategic blood pressure treatment and fluid management could prevent the development of hemorrhagic stroke. American Association of Neurological Surgeons 2022-05-09 /pmc/articles/PMC9379730/ http://dx.doi.org/10.3171/CASE2274 Text en © 2022 The authors https://creativecommons.org/licenses/by-nc-nd/4.0/CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ).
spellingShingle Case Lesson
Araki, Yoshio
Mamiya, Takashi
Fujita, Naotoshi
Yokoyama, Kinya
Uda, Kenji
Kanamori, Fumiaki
Takayanagi, Kai
Ishii, Kazuki
Nishihori, Masahiro
Takeuchi, Kazuhito
Tanahashi, Kuniaki
Nagata, Yuichi
Nishimura, Yusuke
Tanei, Takafumi
Muraoka, Shinsuke
Izumi, Takashi
Kato, Katsuhiko
Saito, Ryuta
Symptomatic hyperperfusion after combined revascularization surgery in patients with pediatric moyamoya disease: patient series
title Symptomatic hyperperfusion after combined revascularization surgery in patients with pediatric moyamoya disease: patient series
title_full Symptomatic hyperperfusion after combined revascularization surgery in patients with pediatric moyamoya disease: patient series
title_fullStr Symptomatic hyperperfusion after combined revascularization surgery in patients with pediatric moyamoya disease: patient series
title_full_unstemmed Symptomatic hyperperfusion after combined revascularization surgery in patients with pediatric moyamoya disease: patient series
title_short Symptomatic hyperperfusion after combined revascularization surgery in patients with pediatric moyamoya disease: patient series
title_sort symptomatic hyperperfusion after combined revascularization surgery in patients with pediatric moyamoya disease: patient series
topic Case Lesson
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379730/
http://dx.doi.org/10.3171/CASE2274
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