Tao Tianshu, Wei Wei, Wan Guiping, Chen Jincao, Li Xiang, Zhang Jianjian
Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.
Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.
J Neurosurg Case Lessons. 2025 Aug 18;10(7). doi: 10.3171/CASE24600.
Cerebral hyperperfusion (CHP) is a serious complication after bypass surgery in moyamoya disease (MMD). Currently, the prediction or diagnosis of CHP relies on various blood flow monitoring devices, and there is a lack of direct signs to predict the occurrence of CHP.
The authors report on the case of a patient with MMD in whom the cortical veins were immediately reddened during superficial temporal artery (STA)-middle cerebral artery (MCA) bypass. On declamping the proximal STA during the operation, the blue vein near the anastomosis was rapidly arterialized under the microscope. Indocyanine green videography showed filling of the vein in the arterial phase, with a notable rise in venous blood flow, monitored by intraoperative laser speckle contrast imaging, and postoperative SPECT imaging demonstrated hyperperfusion in the territory of the MCA.
The intraoperative venous reddening phenomenon indicated that the dramatic changes in venous blood flow may reflect CHP status after STA-MCA bypass surgery. https://thejns.org/doi/10.3171/CASE24600.
脑过度灌注（CHP）是烟雾病（MMD）搭桥手术后的一种严重并发症。目前，CHP的预测或诊断依赖于各种血流监测设备，且缺乏预测CHP发生的直接征象。
作者报告了1例MMD患者，在颞浅动脉（STA）-大脑中动脉（MCA）搭桥手术期间，皮质静脉立即发红。手术中在松开STA近端夹闭时，吻合口附近的蓝色静脉在显微镜下迅速动脉化。吲哚菁绿血管造影显示静脉在动脉期充盈，术中激光散斑对比成像监测显示静脉血流显著增加，术后SPECT成像显示MCA区域存在过度灌注。
术中静脉发红现象表明，静脉血流的显著变化可能反映了STA-MCA搭桥手术后的CHP状态。https://thejns.org/doi/10.3171/CASE24600 。
