Peri-operative complications in adult moyamoya disease.

The incidence and causes of peri-operative haemodynamic complications in adult Moyamoya disease were examined by reviewing 55 surgically treated adult patients. Ninety-nine craniotomies were performed in these patients, and eight peri-operative complications (four infarctions, two haemorrhagic infarctions and two reversible ischaemic neurological deficits without a new lesion) were seen. All of the eight haemodynamic complications arose in the initially affected hemispheres regardless of the side of operation. Some nonsurgical haemodynamic risk factors, i.e., hypercapnia, hypocapnia and hypotension/hypovolaemia, were noted in all of the eight cases, although the statistical analysis could not clarify the relevance of such factors to peri-operative complications. Surgical factors which might be responsible for the complications were noted in three cases. Sparing vital collateral vessels and minimum brain retraction as well as avoidance of non-surgical haemodynamic risk factors are considered to be essential to prevent peri-operative haemodynamic brain damage in adult Moyamoya disease.