Perioperative factors related to the development of ischemic complications in patients with moyamoya disease.

In purpose of clarifying the risk factors of perioperative ischemic complications in cases with moyamoya disease, a retrospective study was conducted on the perioperative care of 36 patients who underwent vascular reconstruction for moyamoya disease. Following surgery, 8 patients developed ischemic complications (5 with minor completed strokes and 3 with transient ischemic attacks). Three factors including the presence of a preoperative low density area (LDA), intra-operative urinary output, and a reduction in the hematocrit significantly differed with complications and those without. In an evaluation of individual cases, intra-operative hypercapnia, hypotension, and a reduction in the circulating blood volume also were identified as potential factors associated with complications. On the basis of these findings, it was concluded that it is necessary to infuse an adequate amount of fluids, maintain normocapnic and normothermic states, and actively correct anemia in patients undergoing vascular reconstruction for moyamoya disease. It is also necessary to pay particular attention to perioperative care in patients in whom a LDA is detected by preoperative CT.