Cerebral Hyperperfusion Syndrome following Arterial Bypass Surgery for Chronic Cerebrovascular Occlusive Disease(<SPECIAL ISSUES>Current Strategies of Extracranial-Intracranial Bypass Surgery)

The present study examined whether preoperatively reduced cerebrovascular contractile reactivity to hypocapnia by hyperventilation is associated with development of cerebral hyperperfusion syndrome after arterial bypass surgery for adult patients with cerebral misery perfusion due to ischemic moyamoya disease. Among 65 adult patients with ischemic moyamoya disease, 19 had misery perfusion in the precentral region on preoperative 15O positron emission tomography and underwent arterial bypass surgery for that region. Brain technetium-99 m-labeled ethyl cysteinate dimer single-photon emission computed tomography (SPECT) was preoperatively performed with and without hyperventilation challenge and relative cerebrovascular contractile reactivity to hypocapnia (RCVCRhypocap) (%/mmHg) was calculated in the precentral region. Development of cerebral hyperperfusion syndrome was determined using perioperative changes of symptoms and brain N-isopropyl-p-[123I]-iodoamphetamine SPECT performed after surgery. RCVCRhypocap was significantly lower in the 6 patients with cerebral hyperperfusion syndrome (−2.85 ± 1.10%/mmHg) than in the 13 patients without cerebral hyperperfusion syndrome (0.18 ± 1.97%/mmHg; p = 0.0050). Multivariate analysis demonstrated low RCVCRhypocap as an independent predictor of cerebral hyperperfusion syndrome (95% confidence interval, 0.04–0.96; p = 0.0433). Preoperatively reduced cerebrovascular contractile reactivity to hypocapnia by hyperventilation is associated with development of cerebral hyperperfusion syndrome after arterial bypass surgery for adult patients with cerebral misery perfusion due to ischemic moyamoya disease.

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Transient Symptomatic Downregulation of Cortical Neurotransmitter Receptor Function Due to Cerebral Hyperperfusion after Arterial Bypass Surgery for a Patient with Ischemic Moyamoya Disease

Neurologia medico-chirurgica ◽

10.2176/nmc.cr.2018-0143 ◽

2018 ◽

Vol 58 (11) ◽

pp. 481-484 ◽

Cited By ~ 4

Author(s):

Yasuyoshi SHIMADA ◽

Daigo KOJIMA ◽

Jun YOSHIDA ◽

Masakazu KOBAYASHI ◽

Kenji YOSHIDA ◽

...

Keyword(s):

Moyamoya Disease ◽

Bypass Surgery ◽

Receptor Function ◽

Neurotransmitter Receptor ◽

Arterial Bypass ◽

Cerebral Hyperperfusion ◽

Arterial Bypass Surgery

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Predicting the Occurrence of Hemorrhagic Cerebral Hyperperfusion Syndrome Using Regional Cerebral Blood Flow After Direct Bypass Surgery in Patients with Moyamoya Disease

World Neurosurgery ◽

10.1016/j.wneu.2018.07.258 ◽

2018 ◽

Vol 119 ◽

pp. e750-e756 ◽

Cited By ~ 4

Author(s):

Tatsuya Ishikawa ◽

Koji Yamaguchi ◽

Akitsugu Kawashima ◽

Takayuki Funatsu ◽

Seiichiro Eguchi ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Moyamoya Disease ◽

Regional Cerebral Blood Flow ◽

Bypass Surgery ◽

Regional Cerebral Blood ◽

Cerebral Hyperperfusion Syndrome ◽

Hyperperfusion Syndrome ◽

Cerebral Hyperperfusion ◽

Direct Bypass

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Comparative Effectiveness of Preventive and Treatment Interventions for Cerebral Hyperperfusion Syndrome Following Bypass Surgery

Neurosurgery ◽

10.1093/neuros/nyz310_501 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Georgios P Skandalakis ◽

Aristotelis Kalyvas ◽

Evgenia Lani ◽

Spyridon Komaitis ◽

Despoina Chatzopoulou ◽

...

Keyword(s):

Bypass Surgery ◽

Meta Analysis ◽

Antiplatelet Agent ◽

Free Radical Scavenger ◽

Cochrane Library ◽

Mortality Data ◽

Radical Scavenger ◽

Cerebral Hyperperfusion Syndrome ◽

Hyperperfusion Syndrome ◽

Cerebral Hyperperfusion

Abstract INTRODUCTION Although cerebral hyperperfusion syndrome (CHS) remains a major complication of bypass surgery that can lead to severe neurological morbidity and mortality, data regarding its prevention and treatment have not been assorted until date. Thus, we systematically reviewed the literature, to assess available data and evaluate whether any conclusions can be drawn regarding the effectiveness of utilized interventions on either preventing or treating bypass related CHS. METHODS We systematically reviewed PubMed & Cochrane Library from September 2008 to September 2018 according to PRISMA, to collect data regarding the effectiveness of pharmacologic interventions on the prevention (PRE) and treatment (TRE) of bypass-related CHS. We categorized interventions regarding their class of drugs and their combinations and calculated overall pooled estimates of the proportions of CHS development or improvement through random-effects meta-analyses of proportions using a Freeman-Tukey double arcsine transformation. RESULTS Our search yielded 646 studies of which 40 fulfilled inclusion criteria. Meta-analysis of PRE included 23 studies/2041 cases. In group [A] (BP control) 202 out of 1174 pretreated cases developed CHS (23.3% pooled estimate; 95% CI 9.9-39.4), in group [B] (BP control + Free Radical Scavenger (FRS)) 10/263 pretreated cases developed CHS (0.3%; 95% CI 0.0-14.1), in group [C] (BP control + antiplatelet) 22/204 pretreated cases developed CHS (10.3%; 95% CI 5.1-16.7), and in group [D] (BP control + Postoperative sedation) 29/400 pretreated cases developed CHS (6.8%; 95% CI 4.4-9.6)]. Meta-analysis of TRE included 29 studies/144 cases that developed CHS. Pooled estimates of improvement ranged from 92.1% to 100.0%. CONCLUSION Our data suggest that BP control alone as a pretreatment has not been proven effective in preventing CHS. However, BP control along with either postoperative sedation or an FRS or an antiplatelet agent seem to reduce the incidence of CHS. Once CHS has developed, BP control and/or FRS administration may ameliorate symptoms.

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Impact of cerebral blood flow changes due to arterial bypass surgery on cognitive function in adult patients with symptomatic ischemic moyamoya disease

Journal of Neurosurgery ◽

10.3171/2018.7.jns18149 ◽

2019 ◽

Vol 131 (6) ◽

pp. 1716-1724 ◽

Cited By ~ 2

Author(s):

Wataru Yanagihara ◽

Kohei Chida ◽

Masakazu Kobayashi ◽

Yoshitaka Kubo ◽

Kenji Yoshida ◽

...

Keyword(s):

Cognitive Function ◽

Bypass Surgery ◽

Brain Perfusion ◽

Acute Stage ◽

Adult Patients ◽

Arterial Bypass ◽

Cognitive Improvement ◽

Cerebral Hyperperfusion ◽

Misery Perfusion ◽

Arterial Bypass Surgery

OBJECTIVESome adult patients with moyamoya disease (MMD) undergoing revascularization surgery show an improvement or decline in cognition postoperatively. Revascularization surgery for ischemic MMD augments cerebral blood flow (CBF) and improves cerebral oxygen metabolism. However, cerebral hyperperfusion, which is a short-term, major increase in ipsilateral CBF that is much greater than the metabolic needs of the brain, sometimes occurs as a complication. Cerebral hyperperfusion produces widespread, minimal injury to the ipsilateral white matter and cortical regions. The aim of the present prospective study was to determine how changes in CBF due to arterial bypass surgery affect cognitive function in adult patients with symptomatic ischemic MMD and misery perfusion.METHODSThirty-two patients with cerebral misery perfusion, as determined on the basis of 15O gas positron emission tomography, underwent single superficial temporal artery–middle cerebral artery (M4 in the precentral region) anastomosis. Brain perfusion single-photon emission computed tomography (SPECT) studies were performed preoperatively, on the 1st postoperative day, and 2 months after surgery. Neuropsychological tests were also performed preoperatively and 2 months after surgery.RESULTSPostoperative neuropsychological assessments demonstrated cognitive improvement in 10 cases (31%), no change in 8 cases (25%), and decline in 14 cases (44%). Based on brain perfusion SPECT and symptoms, 10 patients were considered to have cerebral hyperperfusion syndrome, and all of these patients exhibited a postoperative decline in cognition. Relative precentral CBF on the 1st postoperative day was significantly greater in patients with postoperative cognitive decline (167.3% ± 15.3%) than in those with improved (105.3% ± 18.2%; p < 0.0001) or unchanged (131.4% ± 32.1%; p = 0.0029) cognition. The difference between relative precentral CBF 2 months after surgery and that before surgery was significantly greater in patients with postoperative cognitive improvement (17.2% ± 3.8%) than in those with no postoperative change (10.1% ± 2.4%; p = 0.0003) or with postoperative decline (11.5% ± 3.2%; p = 0.0009) in cognition.CONCLUSIONSCerebral hyperperfusion in the acute stage after arterial bypass surgery impairs cognitive function. An increase in CBF in the chronic stage without acute-stage cerebral hyperperfusion improves cognitive function in adult patients with symptomatic ischemic MMD and misery perfusion.

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Cerebral Hyperperfusion Syndrome After Superficial Temporal Artery-middle Cerebral Artery Bypass for Severe Intracranial Steno-occlusive Disease: A Case Control Study

Neurosurgery ◽

10.1227/neu.0b013e31828bb8b3 ◽

2013 ◽

Vol 72 (6) ◽

pp. 936-943 ◽

Cited By ~ 8

Author(s):

Kejia Teo ◽

David K.S. Choy ◽

Sein Lwin ◽

Chou Ning ◽

Tseng Tsai Yeo ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Bypass Surgery ◽

Internal Carotid ◽

Artery Bypass ◽

Neurological Deficits ◽

External Carotid ◽

Cerebral Hyperperfusion Syndrome ◽

Hyperperfusion Syndrome ◽

Cerebral Hyperperfusion

Abstract BACKGROUND: Intracranial stenoses carry increased risk for cerebral ischemia. We perform external carotid-internal carotid (EC-IC) artery bypass in our patients with severe stenosis of the intracranial internal carotid (ICA) or middle cerebral artery (MCA) with impaired cerebral vasodilatory reserve (CVR). OBJECTIVE: To evaluate cerebral hemodynamics and cerebral hyperperfusion syndrome (HPS) in patients who develop focal neurological deficits after EC-IC bypass surgery. METHODS: Patients with severe intracranial ICA or MCA stenosis and impaired CVR on transcranial Doppler (TCD) derived breath-holding index (BHI) were evaluated with acetazolamide-challenged technetium-99m hexamethylpropyleneamineoxime–single-photon emission computed tomography (SPECT). EC-IC bypass surgery was offered to patients with impaired CVR on SPECT. Close monitoring was performed in patients developing focal neurological deficits within 7 days of surgery. RESULTS: Of 112 patients with severe intracranial ICA/MCA stenosis, 77 (69%) showed impaired CVR and 46 (41%) underwent EC-IC bypass. Transient neurological deficits within 7 days of surgery developed in 8 (17%). HPS was confirmed by CT perfusion and/or SPECT in 7 cases. A strong correlation was observed between HPS and preoperative TCD-BHI values (0%, 6.3%, and 41% in patients with BHI 0.3-0.69, 0-0.3 and <0, respectively; P = .012). HPS patients showed more than a 50% increase in MCA flow velocity on TCD (compared with preoperative values) on the operated side (63.3% vs 3.3% on control side, P < .001). Meticulous control of blood pressure and hydration led to rapid and complete resolution of neurological deficits in all cases. CONCLUSION: Symptomatic cerebral HPS is common in the early postoperative period after EC-IC bypass surgery. Early diagnosis and appropriate management might prevent the complications of this syndrome.

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