Tashiro Ryosuke, Fujimura Miki, Nishizawa Taketo, Tominaga Keita, Kanoke Atushi, Endo Hidenori
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
Cerebrovasc Dis. 2025 Jun 12:1-8. doi: 10.1159/000546826.
The focal cerebral hyperperfusion (CHP) is a potential complication after superficial temporal artery-middle cerebral artery (STA-MCA) bypass for moyamoya disease (MMD) that can result in delayed intracerebral hemorrhage and/or neurological deterioration. The focal CHP could accompany hemodynamic ischemia due to the "watershed shift (WS) phenomenon." Preoperative prediction of the focal CHP and WS phenomenon remains challenging. Here, we aimed to assess the diagnostic value of the "to and fro" conflict sign, conflicting blood flow around the vascular territory of the recipient arteries on an indocyanine green video angiography (ICG-VA) for predicting the focal CHP and WS phenomenon.
Ninety-seven consecutive adult patients with MMD, undergoing 106 surgeries, were enrolled. Serial quantitative analysis of cerebral blood flow was routinely conducted using
The incidence of the focal CHP and WS phenomenon was 29.2% (31/106) and 10.4% (11/106), respectively. The "to and fro" conflict sign was evident in 35.5% (11/31) and 54.5% (6/11) of MMD patients with the focal CHP and WS phenomenon, respectively. The "to and fro" conflict sign was significantly associated with both the focal CHP and WS phenomena.
The "to and fro" conflict sign on ICG-VA may serve as an intraoperative warning sign of the focal CHP and WS phenomenon after STA-MCA bypass in adult patients with MMD, providing neurosurgeons with a valuable tool for early detection.
局灶性脑血流灌注增加（CHP）是烟雾病（MMD）患者行颞浅动脉-大脑中动脉（STA-MCA）搭桥术后的一种潜在并发症，可导致迟发性脑出血和/或神经功能恶化。局灶性CHP可能伴随因“分水岭转移（WS）现象”导致的血流动力学缺血。术前预测局灶性CHP和WS现象仍然具有挑战性。在此，我们旨在评估吲哚菁绿视频血管造影（ICG-VA）上受血动脉血管区域周围的“往返”冲突征（即血流冲突）对预测局灶性CHP和WS现象的诊断价值。
连续纳入97例接受106次手术的成年MMD患者。术前以及STA-MCA搭桥术后第1天和第7天，常规使用
局灶性CHP和WS现象的发生率分别为29.2%（31/106）和10.4%（11/106）。在发生局灶性CHP和WS现象的MMD患者中，分别有35.5%（11/31）和54.5%（6/11）出现“往返”冲突征。“往返”冲突征与局灶性CHP和WS现象均显著相关。
ICG-VA上的“往返”冲突征可能是成年MMD患者STA-MCA搭桥术后局灶性CHP和WS现象的术中警示征象，为神经外科医生提供了一种早期检测的有价值工具。
