Analysis of risk factors for cerebral hyperperfusion syndrome after superficial temporal artery-middle cerebral artery bypass in adults with moyamoya disease
Objective To explore the clinical characteristics and risk factors of cerebral hyperperfusion syndrome(CHS)after superficial temporal artery-middle cerebral artery(STA-MCA)bypass surgery in adults with moyamoya disease.Methods A retrospective analysis was performed on the clinical data of 213 adult patients with moyamoya disease treated by STA-MCA bypass combined with temporalis muscle taping or multi-point drilling in the skull at the Department of Neurosurgery,the First Affiliated Hospital of Harbin Medical University from August 2019 to September 2022.According to whether patients developed CHS 14 days after surgery,they were divided into CHS group and non-CHS group.The clinical outcome of the patients was evaluated based on the modified Rankin Scale score(mRS)3 months after surgery.Univariate analysis and multivariate logistic regression model analysis methods were used to explore the risk factors for CHS after STA-MCA bypass surgery in patients with moyamoya disease.Results Among 213 patients,35 cases(16.4％)developed CHS after surgery,including 5 cases(14.3％)of cerebral hemorrhage,6 cases(17.1％)of focal epileptic seizures,and 24 cases(68.6％)of transient neurological dysfunction.Three months after surgery,202 cases had mRS scores of 0 to 2 points,and 11 cases had mRS scores of 3 to 6 points.Three months after surgery,the mRS of the CHS group was 1(0,1),of which 94.3％(33/35)were 0 to 2;the mRS of the non-CHS group was 1(0,1),of which 94.9％(169/178)scored 0 to 2 points,and the difference between the two groups was not statistically significant(x2=0.59,P=0.441).The results of univariate analysis showed that there were statistically significant differences between the CHS group and the non-CHS group in terms of history of hypertension,cerebral hemorrhage as the first symptom,advanced Suzuki stage on the surgical side(stages Ⅳ to Ⅵ),or preoperative serum hematocrit(all P＜0.05).Multivariate logistic regression analysis showed that patient's history of hypertension(OR=3.69,95％CI:1.52-9.00,P=0.004),cerebral hemorrhage as the first symptom(OR=3.21,95％CI;1.08-9.54;P=0.036)and higher preoperative hematocrit level(OR=1.17,95％CI:1.06-1.29,P=0.002)were all risk factors for CHS in patients with moyamoya disease after STA-MCA bypass surgery.Conclusions CHS in adult patients with moyamoya disease after STA-MCA bypass surgery mostly manifests as transient neurological dysfunction,and the prognosis of the patients 3 months after surgery is not significantly different from that of patients without CHS.Adult patients with moyamoya disease who have a history of hypertension,whose first symptom is cerebral hemorrhage,and who have a high preoperative hematocrit level are more likely to develop CHS after STA-MCA bypass surgery.
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