• Yoshio Araki, Kinya Yokoyama, Kenji Uda, Fumiaki Kanamori, Kai Takayanagi, Kazuki Ishii, Masahiro Nishihori, Shunsaku Goto, Tetsuya Tsukada, Kazuhito Takeuchi, Kuniaki Tanahashi, Yuichi Nagata, Yusuke Nishimura, Takafumi Tanei, Yoshitaka Nagashima, Shinsuke Muraoka, Takashi Izumi, Yukio Seki, and Ryuta Saito.
• Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan. Electronic address: y.araki@med.nagoya-u.ac.jp.
• World Neurosurg. 2024 Jul 1; 187: e610e619e610-e619.

ObjectiveTransient neurological deficits (TNDs) are known to develop after direct bypass for Moyamoya disease and may be risk factors for subsequent stroke. However, the factors involved in the development of TNDs and stroke after indirect revascularization alone, including their association with subsequent stroke, remain unclear. The purpose of this study was to investigate this issue.MethodsThe subjects of the study were 30 patients with Moyamoya disease who underwent a total of 40 indirect revascularization procedures at our institution. Clinical and radiological data were collected retrospectively. To examine factors associated with the development of postoperative TND/stroke/asymptomatic disease, the clinical characteristics of each group were statistically compared.ResultsThe mean age at surgery was 7 years (range 1-63). TNDs developed after surgery in 9 out of 40 patients (22.5%). Stroke in the acute postoperative period occurred in 3 patients (7.5%), all of whom experienced cerebral infarctions. Demographic data and preoperative clinical information were not different between the groups. However, posterior cerebral artery involvement on preoperative imaging was significantly associated with the development of TNDs and stroke (P = 0.006). Furthermore, postoperative stroke was associated with unfavorable outcomes (P = 0.025).ConclusionsPosterior cerebral artery involvement is significantly associated with the occurrence of TNDs. In contrast, TNDs after indirect revascularization have little relationship with the subsequent development of stroke. TNDs usually resolve without new strokes, and a better understanding of this particular pathology could help establish an optimal treatment regimen.Copyright © 2024 Elsevier Inc. All rights reserved.

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