• Yusuke Egashira, Keita Yamauchi, Yukiko Enomoto, Noriyuki Nakayama, Shinichi Yoshimura, and Toru Iwama.
• Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan. Electronic address: egashi@gifu-u.ac.jp.
• World Neurosurg. 2017 Apr 1; 100: 311-315.

ObjectiveTransient neurologic events (TNEs) frequently occur after revascularization in adult moyamoya disease (MMD). In the present study, we hypothesized that cortical arterial network disruption may be associated with TNE severity after bypass surgery.MethodsThis retrospective study included 76 hemispheres in 45 consecutive adult patients with MMD who underwent direct revascularization surgery at our institution. We classified cortical arterial network disruption grade (NDG) into the following 4 categories based on angiography: NDG 0, >90% of suprasylvian cortical branches of the middle cerebral artery showed anterograde filling; NDG 1, 50%-90%; NDG 2, <50%; and NDG 3, none. TNE severity was assigned 1 of 4 grades based on symptom duration and clinical features: grade 0, none; grade 1, mild; grade 2, moderate; and grade 3, severe. We evaluated multiple clinical characteristics, including NDG, to identify factors that have a significant association with TNE severity.ResultsOf the 73 hemispheres without perioperative ischemic or hemorrhagic complications, the following degrees of TNEs were developed: grade 0, 33%; grade 1, 30%; grade 2, 22%; and grade 3, 15%. We determined that NDG and left-side surgery were significantly associated with TNE severity (P < 0.01 and P = 0.04, respectively). The NDG had excellent interobserver reliability (weighted κ value = 0.96). There were no significant correlations between TNE severity and other clinical backgrounds.ConclusionsNDG is useful for the prediction of severity of TNEs after revascularization. Disturbed bypass flow spreading may lead to the development of TNEs in adult MMD.Copyright © 2017 Elsevier Inc. All rights reserved.

34 keywords...

hide…