Predictors and clinical features of transient neurological events after combined bypass revascularization for moyamoya disease

被引:16
作者
Lu, Junlin [1 ]
Zhao, Yahui [1 ]
Ma, Li [1 ]
Chen, Yu [1 ]
Li, Mingtao [1 ]
Chen, Xiaolin [1 ]
Ye, Xun [1 ]
Wang, Rong [1 ,2 ,3 ,5 ]
Zhao, Yuanli [1 ,2 ,3 ,4 ,5 ]
机构
[1] Capital Med Univ, Beijing Tiantan Hosp, Dept Neurosurg, 119 South Fourth Ring West Rd, Beijing 100070, Peoples R China
[2] China Natl Clin Res Ctr Neurol Dis, Beijing, Peoples R China
[3] Beijing Inst Brain Disorders, Ctr Stroke, Beijing, Peoples R China
[4] Beijing Key Lab Translat Med Cerebrovasc Dis, Beijing, Peoples R China
[5] Peking Univ, Int Hosp, Dept Neurosurg, Beijing, Peoples R China
基金
中国国家自然科学基金;
关键词
Moyamoya diease; Transient neurological events; Combined bypass; Vascular disorders; EXTRACRANIAL-INTRACRANIAL BYPASS; SUPERFICIAL TEMPORAL ARTERY; SUBCORTICAL LOW-INTENSITY; CEREBRAL HYPERPERFUSION; SURGICAL REVASCULARIZATION; SURGERY; DETERIORATION; ANASTOMOSIS; ESTROGENS; ANTERIOR;
D O I
10.1016/j.clineuro.2019.105505
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: Transient neurological events (TNEs) are frequently observed after revascularization surgery for moyamoya disease (MMD). However, clinical features and pathophysiology of TNEs in MMD are still unclear. This study was aimed to clarify the incidence and time course of TNEs and to determine the independent predictors of TNEs in MMD. Patients and methods: A total of 195 hemispheres in 171 consecutive patients with MMD who had undergone combined direct and indirect bypass surgery were analyzed. Preoperative clinical characteristics and radiographic features were recorded. The incidence and clinical feature of postoperative TNEs were evaluated. Multivariate logistic regression analyses were performed to identify the risk factors for postoperative TNEs. Outcomes were compared between patients who had TNEs with those without TNEs at the time of discharge. Results: Postoperative TNEs were detected in 40 (20.5%) of 195 operated hemispheres, including 17 (42.5%) aphasia, 9 numbness of the extremities (22.5%), 6 seizures (15%), 5 motor weakness (12.5%), 4 dysarthria (10%) and 6 others (15%). The incidence of TNEs was significantly higher in adult patients than in pediatric ones. Multivariate analysis revealed that female, left-sided surgery and the presence of the edematous lesion was an independent predictor of TNEs after surgery in MMD (OR, 3.0; 95% CI, 1.1-8.2; P = 0.03, OR, 2.9; 95% CI, 1.2-7.0; P = 0.02 and OR, 17.4; 95% CI, 5.7-53.0; P < 0.01, respectively). DSA stage (OR 0.05, 95% CI 0.0-0.5, p = 0.005; OR 0.08, 95% CI 0.0-0.4, p = 0.008), PCA involvement (OR 2.75, 95% CI 1.0-7.4, p = 0.046), left-sided surgery (OR 2.73, 95% CI 1.2-6.5, p = 0.022) and edematous lesion (OR 21.2, 95% CI 7.6-59.7, < 0.001) were significantly associated with TNE severity. Compared with patients without postoperative TNEs, no significant differences in mRS score between the two groups were detected. Conclusions: Female, left-sided surgery and edematous lesion were independent risk factors for postoperative TNEs; the left-sided surgery and edematous lesion were also independently associated with the severity of TNE. Although patients with postoperative TNEs had worse neurological status during the perioperative period, postoperative TNEs had no associations with worse mRS score at the time of discharge.
引用
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页数:8
相关论文
共 40 条
[1]   Disruption of Cortical Arterial Network is Associated with the Severity of Transient Neurologic Events After Direct Bypass Surgery in Adult Moyamoya Disease [J].
Egashira, Yusuke ;
Yamauchi, Keita ;
Enomoto, Yukiko ;
Nakayama, Noriyuki ;
Yoshimura, Shinichi ;
Iwama, Toru .
WORLD NEUROSURGERY, 2017, 100 :311-315
[2]   Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease [J].
Fujimura, Miki ;
Kaneta, Tomohiro ;
Mugikura, Shunji ;
Shimizu, Hiroaki ;
Tominaga, Teiji .
SURGICAL NEUROLOGY, 2007, 67 (03) :273-282
[3]   Minocycline Prevents Focal Neurological Deterioration Due to Cerebral Hyperperfusion After Extracranial-Intracranial Bypass for Moyamoya Disease [J].
Fujimura, Miki ;
Niizuma, Kuniyasu ;
Inoue, Takashi ;
Sato, Kenichi ;
Endo, Hidenori ;
Shimizu, Hiroaki ;
Tominaga, Teiji .
NEUROSURGERY, 2014, 74 (02) :163-170
[4]   Significance of Focal Cerebral Hyperperfusion as a Cause of Transient Neurologic Deterioration After Extracranial-Intracranial Bypass for Moyamoya Disease: Comparative Study With Non-Moyamoya Patients Using N-Isopropyl-p-[123I]Iodoamphetamine Single-Photon Emission Computed Tomography [J].
Fujimura, Miki ;
Shimizu, Hiroaki ;
Inoue, Takashi ;
Mugikura, Shunji ;
Saito, Atsushi ;
Tominaga, Teiji .
NEUROSURGERY, 2011, 68 (04) :957-964
[5]   Delayed intracerebral hemorrhage after superficial temporal artery-middle cerebral artery anastomosis in a patient with moyamoya disease: possible involvement of cerebral hyperperfusion and increased vascular permeability [J].
Fujimura, Miki ;
Shimizu, Hiroaki ;
Mugikura, Shunji ;
Tominaga, Teiji .
SURGICAL NEUROLOGY, 2009, 71 (02) :223-227
[6]   Unstable moyamoya disease: clinical features and impact on perioperative ischemic complications [J].
Funaki, Takeshi ;
Takahashi, Jun C. ;
Takagi, Yasushi ;
Kikuchi, Takayuki ;
Yoshida, Kazumichi ;
Mitsuhara, Takafumi ;
Kataoka, Hiroharu ;
Okada, Tomohisa ;
Fushimi, Yasutaka ;
Miyamoto, Susumu .
JOURNAL OF NEUROSURGERY, 2015, 122 (02) :400-407
[7]   The role of nitric oxide in coronary vascular effects of estrogen in postmenopausal women [J].
Guetta, V ;
Quyyumi, AA ;
Prasad, A ;
Panza, JA ;
Waclawiw, M ;
Cannon, RO .
CIRCULATION, 1997, 96 (09) :2795-2801
[8]   Clinical outcome after 450 revascularization procedures for moyamoya disease [J].
Guzman, Raphael ;
Lee, Marco ;
Achrol, Achal ;
Bell-Stephens, Teresa ;
Kelly, Michael ;
Do, Huy M. ;
Marks, Michael P. ;
Steinberg, Gary K. .
JOURNAL OF NEUROSURGERY, 2009, 111 (05) :927-935
[9]   Clinical implications of the cortical hyperintensity belt sign in fluid-attenuated inversion recovery images after bypass surgery for moyamoya disease [J].
Hamano, Eika ;
Kataoka, Hiroharu ;
Morita, Naomi ;
Maruyama, Daisuke ;
Satow, Tetsu ;
Iihara, Koji ;
Takahashi, Jun C. .
JOURNAL OF NEUROSURGERY, 2017, 126 (01) :1-7
[10]   Measurement of Cerebrovascular Reactivity in Pediatric Patients With Cerebral Vasculopathy Using Blood Oxygen Level-Dependent MRI [J].
Han, Jay S. ;
Mikulis, David J. ;
Mardimae, Alexandra ;
Kassner, Andrea ;
Poublanc, Julien ;
Crawley, Adrian P. ;
deVeber, Gabrielle A. ;
Fisher, Joseph A. ;
Logan, William J. .
STROKE, 2011, 42 (05) :1261-1269