Edaravone Reduces Hyperperfusion-Related Neurological Deficits in Adult Moyamoya Disease

Background and Purpose: Postoperative hyperperfusion-related transient neurological deficits (TNDs) are frequently observed in adult patients with moyamoya disease (MMD) who undergo direct bypass procedures. The present study evaluated the effect of the free radical scavenger edaravone on postoperative hyperperfusion in adult MMD. Methods: This study included 92 hemispheres in 72 adult patients who underwent direct bypass for MMD. Serial measurements of cerebral blood flow were conducted immediately after surgery and on postoperative days 2 and 7. In 40 hemispheres in 36 patients, edaravone (60 mg/day) was administered from the day of surgery until postsurgical day 7. The incidence of postoperative hyperperfusion and associated TNDs were compared with a control group that included 52 hemispheres in 36 patients. Results: Radiological hyperperfusion was observed in 28/40 (70.0%) and 39/52 (75.0%) hemispheres in the edaravone and control groups, respectively (P = 0.30). Hyperperfusion-related TNDs incidences were significantly lower in the edaravone group compared with the control group (12.5% vs. 32.7%, P = 0.024). Multivariate analysis demonstrated that edaravone administration (P = 0.009) and left-sided surgery (P = 0.037) were significantly correlated with hyperperfusion-related TNDs (odds ratios, 0.3 and 4.2, respectively). Conclusions: Perioperative administration of edaravone reduced the incidence of hyperperfusion-related TNDs after direct bypass procedures in adult patients with MMD.

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Epilepsy After Bypass Surgery in Adult Moyamoya Disease

Neurosurgery ◽

10.1227/neu.0b013e31820c045a ◽

2011 ◽

Vol 68 (5) ◽

pp. 1227-1232 ◽

Cited By ~ 10

Author(s):

Sung-Chul Jin ◽

Chang Wan Oh ◽

O-Ki Kwon ◽

Gyojun Hwang ◽

Jae Seung Bang ◽

...

Keyword(s):

Moyamoya Disease ◽

Multivariable Analysis ◽

Adult Patients ◽

Neurological Deficits ◽

Recipient Artery ◽

Generalized Estimation Equation ◽

Postoperative Seizure ◽

Direct Bypass ◽

Adult Moyamoya Disease ◽

Revascularization Surgery

Abstract BACKGROUND: Postoperative seizure, well-known in association with other pathologies, has been rarely discussed in adult moyamoya disease. OBJECTIVE: We evaluated postoperative seizures in adult patients with moyamoya undergoing revascularization surgery. METHODS: From 2001 to 2007, 43 adult patients with moyamoya disease underwent 53 revascularization surgeries, consisting of direct bypass with or without indirect bypass. Incidence and profile of postoperative seizures were investigated, with evaluation of influencing factors. Multivariable analysis using a generalized estimation equation was performed to determine which factors were related to postoperative seizure. RESULTS: Seizures developed in 10 sides (18.9%) after revascularization for moyamoya disease, including immediate (<24 hours, n = 0), early (1–7 days, n = 5), late (8–30 days, n = 0), and delayed seizures (≥1 month, n = 7). Early and subsequent delayed seizures developed in the same lesions in 2 patients. Seizures developed only in the patients with combined direct and indirect revascularization. Postoperative temporary neurological deficits with imaging abnormalities were significantly related to postoperative nondelayed seizures (P = .02). Delayed seizures were significantly different according to the location of the recipient artery (P = .03), especially with the frontal branches. By multivariable analysis, revascularization using frontal branches trended toward increased incidence of delayed postoperative seizure, with adjusted odds ratio of 13.78 (95% confidence interval, 1.7-114.1). CONCLUSION: In adult patients with moyamoya disease, the incidence of delayed postoperative seizure seems to be higher than that of other pathologies. The delayed, pronounced formation of synangiosis in moyamoya disease may be related to the development of such delayed postoperative seizures, especially when the location of the recipient artery is frontal.

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Intralateral and Perilateral Ventricular Arteries on Original Axial Magnetic Resonance Angiography in Adult Moyamoya Disease

European Neurology ◽

10.1159/000514429 ◽

2021 ◽

Vol 84 (2) ◽

pp. 119-123

Author(s):

Mami Ishikawa ◽

Satoshi Terao ◽

Hiroshi Kagami ◽

Makoto Inaba ◽

Heiji Naritaka

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Cerebral Infarction ◽

Moyamoya Disease ◽

Disease Onset ◽

Time Of Flight ◽

Unruptured Aneurysms ◽

Tof Mra ◽

Adult Moyamoya Disease

Background: Patients with moyamoya disease often develop cerebral infarction and hemorrhage, but the ischemic and hemorrhagic subtypes are difficult to diagnose prior to disease onset. We aimed to differentiate the ischemic and hemorrhagic subtypes of moyamoya disease by analyzing the intralateral and perilateral ventricular arteries on the original axial magnetic resonance angiography (MRA) images. Methods: We retrospectively analyzed the intralateral and perilateral ventricular arteries on the original axial time-of-flight (TOF)-MRA images of 18 patients with hemorrhagic moyamoya disease, 25 patients with ischemic moyamoya disease, and 22 control patients with unruptured aneurysms. Results: There were significantly more intralateral and perilateral ventricular arteries on the original axial MRA images in the patients with hemorrhagic moyamoya disease (6.3 ± 2.7) than in those with ischemic moyamoya disease (0.8 ± 0.9) and those with unruptured aneurysms (0.4 ± 0.8). Conclusion: The intralateral and perilateral ventricular arteries on the original axial TOF-MRA images might suggest the hemorrhagic type of moyamoya disease prior to onset.

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