大脑高灌注综合征在重度颅内狭窄性疾病行颞浅动脉-大脑中动脉搭桥术后：一项病例对照研究。

Cerebral hyperperfusion syndrome after superficial temporal artery-middle cerebral artery bypass for severe intracranial steno-occlusive disease: a case control study.

机构信息

Division of Neurosurgery, National University Hospital, Singapore.

出版信息

Neurosurgery. 2013 Jun;72(6):936-42; discussion 942-3. doi: 10.1227/NEU.0b013e31828bb8b3.

DOI:10.1227/NEU.0b013e31828bb8b3

PMID:23407293

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.

摘要

背景

颅内狭窄会增加脑缺血的风险。我们对颅内颈内动脉（ICA）或大脑中动脉（MCA）严重狭窄且脑血管扩张储备（CVR）受损的患者进行颈外-颈内（EC-IC）动脉旁路手术。

目的

评估发生 EC-IC 旁路手术后出现局灶性神经功能缺损的患者的脑血流动力学和脑高灌注综合征（HPS）。

方法

对经颅多普勒（TCD）衍生的屏气指数（BHI）显示严重颅内 ICA 或 MCA 狭窄和 CVR 受损的患者进行乙酰唑胺挑战锝-99m 六甲基丙烯胺肟-单光子发射计算机断层扫描（SPECT）评估。对 SPECT 显示 CVR 受损的患者进行 EC-IC 旁路手术。密切监测手术后 7 天内出现局灶性神经功能缺损的患者。

结果

在 112 例严重颅内 ICA/MCA 狭窄患者中，77 例（69%）显示 CVR 受损，46 例（41%）接受了 EC-IC 旁路手术。术后 7 天内出现短暂性神经功能缺损 8 例（17%）。7 例通过 CT 灌注和/或 SPECT 证实了 HPS。HPS 患者的 TCD-BHI 值与术前相比（0%、6.3%和 41%，BHI 值分别为 0.3-0.69、0-0.3 和 <0；P=0.012）。HPS 患者患侧 MCA 血流速度较术前（对侧 3.3%，P<0.001）增加超过 50%。精细控制血压和补液使所有病例的神经功能缺损迅速完全缓解。