• Mami Yamasaki, Hideyuki Yoshioka, Kazuya Kanemaru, Takashi Yagi, Koji Hashimoto, Nobuo Senbokuya, and Hiroyuki Kinouchi.
• Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan.
• World Neurosurg. 2020 Sep 1; 141: 335-338.

BackgroundEarly and late images of single photon emission computed tomography (SPECT) using 123I-iomazenil (123I-IMZ) can demonstrate cerebral blood flow and cortical neuronal viability. Hyperperfusion syndrome is one of the serious complications after revascularization surgery for moyamoya disease; therefore, the real-time observation of the hemodynamics and neuronal viability is important for the treatment after the revascularization. Here we report, a case of moyamoya disease where 123I-IMZ SPECT had a significant efficacy to delineate the hemodynamics and transient neuronal dysfunction in hyperperfusion state after revascularization.Case DescriptionA 47-year-old woman presented with motor aphasia 3 days after superficial temporal artery-middle cerebral artery anastomosis with indirect revascularization. Magnetic resonance imaging (MRI) on the same day showed no new ischemic changes but high intensities along the left frontal sulci observed on fluid-attenuated inversion recovery images, and 123I-IMZ SPECT demonstrated the increased uptake on the early images and the decreased uptake on the late images around the anastomosis site. The patient was completely recovered 1 month after surgery, and abnormal changes on MRI and 123I-IMZ SPECT returned to normal along with the symptom withdrawal.ConclusionsThese findings indicate that 123I-IMZ SPECT could be the index for the treatment of revascularization for obstructive vascular diseases such as moyamoya disease.Copyright © 2020 Elsevier Inc. All rights reserved.

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