Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Department of Neurosurgery, University of Toyama, Toyama, Japan.
Neurosurg Rev. 2021 Feb;44(1):599-605. doi: 10.1007/s10143-020-01265-8. Epub 2020 Feb 19.
Cerebral hyperperfusion (HP) complicates the postoperative course of patients with moyamoya disease (MMD) after direct revascularization surgery. Crossed cerebellar diaschisis (CCD) has been considered to be rarely associated with HP after revascularization surgery. This study aimed to describe the clinical features and factors associated with CCD secondary to cerebral HP after revascularization surgery for MMD. We analyzed 150 consecutive hemispheres including 101 in adults and 49 in pediatric patients who underwent combined direct and indirect bypass for MMD. Using single-photon emission computed tomography (SPECT), serial cerebral blood flow (CBF) was measured immediately after the surgery and on postoperative days 2 and 7. Pre- and postoperative voxel-based analysis of SPECT findings was performed to compare the changes in regional CBF. Multivariate logistic regression analysis was performed to test the effect of multiple variables on CCD. Asymptomatic and symptomatic HP was observed in 41.3% (62/150) and 16.7% (25/150) of the operated hemispheres, respectively. CCD was observed in 18.4% (16/87) of these hemispheres with radiological HP. Multivariate analysis revealed that the occurrence of CCD was significantly associated with symptomatic HP (p = 0.0015). Voxel-based analysis showed that the CBF increase in the operated frontal cortex, and the CBF reduction in the contralateral cerebellar hemisphere on day 7 were significantly larger in symptomatic HP than in asymptomatic HP (median 11.3% vs 7.5%; - 6.0% vs - 1.7%, respectively). CCD secondary to postoperative HP is more common than anticipated in MMD. CCD could potentially be used as an indicator of severe postoperative HP in patients with MMD.
大脑高灌注（HP）是烟雾病（MMD）患者直接血运重建手术后的并发症。交叉性小脑失联络（CCD）被认为很少与血运重建手术后的 HP 相关。本研究旨在描述与 MMD 直接和间接旁路联合手术后 HP 相关的 CCD 的临床特征和相关因素。我们分析了 150 例连续的半脑，其中成人 101 例，儿童 49 例，均接受了 MMD 的联合直接和间接旁路手术。使用单光子发射计算机断层扫描（SPECT），在手术后立即以及第 2 天和第 7 天连续测量脑血流（CBF）。进行 SPECT 结果的基于体素的分析，以比较区域 CBF 的变化。进行多变量逻辑回归分析以测试多个变量对 CCD 的影响。在 150 个手术半球中，分别观察到无症状和有症状的 HP 为 41.3%（62/150）和 16.7%（25/150）。在有影像学 HP 的这些半球中，观察到 CCD 为 18.4%（16/87）。多变量分析显示，CCD 的发生与有症状的 HP 显著相关（p=0.0015）。基于体素的分析显示，在有症状的 HP 中，手术侧额皮质的 CBF 增加和对侧小脑半球的 CBF 减少在第 7 天更为明显（中位数 11.3%对 7.5%；-6.0%对-1.7%）。在 MMD 中，术后 HP 引起的 CCD 比预期更为常见。CCD 可能成为 MMD 患者严重术后 HP 的指标。
