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
[31]   Postoperative temporary neurological deficits in adults with moyamoya disease [J].
Ohue, Shiro ;
Kumon, Yoshiaki ;
Kohno, Kanehisa ;
Watanabe, Hideaki ;
Iwata, Shiinji ;
Ohnishi, Takanori .
SURGICAL NEUROLOGY, 2008, 69 (03) :281-287
[32]   Transient Seizure-Related MRI Abnormalities [J].
Ong, Benjamin ;
Bergin, Patrick ;
Heffernan, Theresa ;
Stuckey, Stephen .
JOURNAL OF NEUROIMAGING, 2009, 19 (04) :301-310
[33]  
Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis, 2012, Neurol Med Chir (Tokyo), V52, P245
[34]   Significance of novel subcortical low intensity score on transient neurological events after revascularization surgery for moyamoya disease [J].
Shiba, Masato ;
Toma, Naoki ;
Tanioka, Satoru ;
Yasuda, Ryuta ;
Sakaida, Hiroshi ;
Suzuki, Hidenori .
CLINICAL NEUROLOGY AND NEUROSURGERY, 2018, 167 :70-75
[35]   MOYAMOYA DISEASE - A REVIEW [J].
SUZUKI, J ;
KODAMA, N .
STROKE, 1983, 14 (01) :104-109
[36]   CEREBROVASCULAR MOYAMOYA DISEASE - DISEASE SHOWING ABNORMAL NET-LIKE VESSELS IN BASE OF BRAIN [J].
SUZUKI, J ;
TAKAKU, A .
ARCHIVES OF NEUROLOGY, 1969, 20 (03) :288-&
[37]   A Case of Moyamoya Disease with a Transient Neurologic Deterioration Associated with Subcortical Low Intensity on Fluid-Attenuated Inversion Recovery Magnetic Resonance Images After Bypass Surgery [J].
Tanioka, Satoru ;
Shiba, Masato ;
Umeda, Yasuyuki ;
Sano, Takanori ;
Maeda, Masayuki ;
Suzuki, Hidenori .
WORLD NEUROSURGERY, 2016, 88 :688.e17-688.e21
[38]   Predictors and Clinical Features of Postoperative Hyperperfusion after Surgical Revascularization for Moyamoya Disease A Serial Single Photon Emission CT/Positron Emission Tomography Study [J].
Uchino, Haruto ;
Kuroda, Satoshi ;
Hirata, Kenji ;
Shiga, Tohru ;
Houkin, Kiyohiro ;
Tamaki, Nagara .
STROKE, 2012, 43 (10) :2610-2616
[40]   Risk factors for and outcomes of postoperative complications in adult patients with moyamoya disease [J].
Zhao, Meng ;
Deng, Xiaofeng ;
Zhang, Dong ;
Wang, Shuo ;
Zhang, Yan ;
Wang, Rong ;
Zhao, Jizong .
JOURNAL OF NEUROSURGERY, 2019, 130 (02) :531-542