Clinical analysis of cerebral hyperperfusion syndrome after cerebrovascular reconstruction in moyamoya disease

Abstract

Objective To investigate the related influencing factors of "de novo ivy sign" in patients with cerebral hyperperfusion syndrome (CHS) after moyamoya disease (MMD) surgery. Methods A total of 45 patients with MMD admitted to Aviation General Hospital from January to December 2019 were enrolled, all of whom underwent superficial temporal artery (STA)⁃middle cerebral artery (MCA) bypass and encephalo⁃duro⁃myo⁃arterio⁃pericranio⁃synangiosis (EDMAPS) and suffered from CHS after surgery. The occurrence rate of "de novo ivy sign" after surgery was recorded. Univariate and multivariate Logistic regression analyses were used to screen the influcencing factors for postoperative "de novo ivy sign". Results In a total of 45 patients, the main manifestations of CHS after left surgery were language disorders in 27 cases (96.43%, 27/28), right limb sensory and motor disorders in 6 cases (21.43%, 6/28), and left limb sensory and motor disorders after right surgery in 9 cases (9/17), salivation and swallowing difficulties in 3 cases (3/17). A total of 26 patients (57.78%) developed "de novo ivy sign" after surgery, which were located in the anterior cerebral artery (ACA) blood supply area (2 cases), the anterior MCA blood supply area (9 cases), the posterior MCA blood supply area (6 cases), the ACA blood supply area and the anterior MCA blood supply area (4 cases), and the anterior and posterior MCA blood supply area (5 cases). The probability of the occurrence of "de novo ivy sign" in the patients without "ivy sign" before surgery, the occurrence time of postoperative CHS ≤ 3 d and the recovery time ≤ 7 d after surgery was higher than that of the patients with "ivy sign" before surgery (χ2 = 5.830, P = 0.016), the occurrence time of postoperative CHS > 3 d (χ2 = 30.162, P = 0.000), and recovery time > 7 d (χ2 = 6.764, P = 0.009). Logistic regression analysis showed only the occurrence time of postoperative CHS ≤ 3 d was a risk factor for postoperative "de novo ivy sign" (OR = 261.155, 95%CI: 7.635-8932.982; P = 0.002). Conclusions The manifestations of CHS after MMD were different in the surgical side. "De novo ivy sign" is a transient hemodynamic change after cerebrovascular reconstruction of MMD, and it is easy to form "de novo ivy sign" in patients who develop CHS within 3 d after surgery.

Keywords

• moyamoya disease
• cerebral revascularization
• hemodynamics
• postoperative complications
• risk factors
• logistic models