术中实时超声联合 FLOW800 预测直接血运重建治疗烟雾病后发生脑过度灌注综合征的初步研究

Intraoperative transit-time ultrasonography combined with FLOW800 predicts the occurrence of cerebral hyperperfusion syndrome after direct revascularization of Moyamoya disease: a preliminary study.

机构信息

Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China.

出版信息

Acta Neurochir (Wien). 2021 Feb;163(2):563-571. doi: 10.1007/s00701-020-04599-w. Epub 2020 Oct 2.

DOI:10.1007/s00701-020-04599-w

PMID:33006072

Abstract

BACKGROUND

Cerebral hyperperfusion syndrome (CHS) is a common complication after direct bypass surgery in patients with Moyamoya disease (MMD). Since preventive measures may be inadequate, we assessed whether the blood flow difference between the superficial temporal artery (STA) and recipient vessels (△BF) and the direct perfusion range (DPR) are related to CHS.

METHODS

We measured blood flow in the STA and recipient blood vessels before bypass surgery by transit-time probe to calculate △BF. Perfusion changes around the anastomosis before and after bypass were analyzed with FLOW800 to obtain DPR. Multiple factors, such as △BF, DPR, and postoperative CHS, were analyzed using binary logistic regression.

RESULTS

Forty-one patients with MMD who underwent direct bypass surgery were included in the study. Postoperative CHS symptoms occurred in 13/41 patients. △BF and DPR significantly differed between the CHS and non-CHS groups. The optimal receiver operating characteristic (ROC) curve cut-off value was 31.4 ml/min for ΔBF, and the area under the ROC curve (AUC) was 0.695 (sensitivity 0.846, specificity 0.500). The optimal cut-off value was 3.5 cm for DPR, and the AUC was 0.702 (sensitivity 0.615, specificity 0.750).

CONCLUSION

Postoperative CHS is caused by multiple factors. △BF is a risk factor for CHS while DPR is a protective factor against CHS.

摘要

背景

大脑高灌注综合征（CHS）是烟雾病患者直接旁路手术后的常见并发症。由于预防措施可能不足，我们评估了颞浅动脉（STA）和受血者血管之间的血流差异（△BF）和直接灌注范围（DPR）是否与 CHS 有关。

方法

我们通过瞬变探头在旁路手术前测量 STA 和受血血管的血流，以计算△BF。使用 FLOW800 分析旁路前后吻合口周围的灌注变化，以获得 DPR。使用二元逻辑回归分析△BF、DPR 和术后 CHS 等多种因素。

结果

本研究纳入了 41 例接受直接旁路手术的烟雾病患者。术后 CHS 症状发生在 13/41 例患者中。CHS 组和非 CHS 组之间的△BF 和 DPR 差异有统计学意义。ΔBF 的最佳受试者工作特征（ROC）曲线截断值为 31.4ml/min，ROC 曲线下面积（AUC）为 0.695（灵敏度 0.846，特异性 0.500）。DPR 的最佳截断值为 3.5cm，AUC 为 0.702（灵敏度 0.615，特异性 0.750）。