• World Neurosurg · Dec 2018

    Postoperative Intracerebral Hemorrhage After Combined Revascularization Surgery in Moyamoya Disease: Profiles and Clinical Associations.

    • Kikutaro Tokairin, Ken Kazumata, Haruto Uchino, Masaki Ito, Kota Ono, Ryota Tatezawa, Takafumi Shindo, Masahito Kawabori, Naoki Nakayama, and Kiyohiro Houkin.
    • Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan. Electronic address: k-tokairin@umin.ac.jp.
    • World Neurosurg. 2018 Dec 1; 120: e593-e600.

    ObjectiveIn combined revascularization surgery for patients with moyamoya disease, intracerebral hemorrhage (ICH) during the postoperative acute phase is a rarely observed but severe complication. Its clinical features remain unclear because of its low incidence rate. The aim of this study was to clarify the clinical characteristics of immediate postoperative ICH.MethodsThe frequency, onset timing, and hematoma location of patients who demonstrated immediate postoperative ICH were investigated in 201 consecutive surgeries performed in 134 patients. Associations between immediate postoperative ICH and demographics, clinical presentation type, perioperative blood pressure (BP), and neuroimaging data were analyzed.ResultsPostoperative ICH was observed in 6 cases (2.99%; mean age, 46.0 ± 7.6 years). The onset timing of ICH was within 24 hours after surgery in most patients (83.3%). Hematomas were located at the subcortical lesion beneath the anastomosed cortex (n = 5) and caudate head (n = 1). Three cases (50.0%) required hematoma evacuation. A higher age at surgery was associated with postoperative ICH (P = 0.046). In adult cases (132 surgeries, 65.7%), hemorrhagic presentation at onset (P = 0.0027) and an increase in BP from pre- to postoperative stage (systolic BP increase: P = 0.0058, diastolic BP increase: P = 0.0274) were significantly associated with postoperative ICH.ConclusionsThe results suggest that older patients, with hemorrhagic presentation and greater postoperative BP increase, should be carefully managed to avoid postoperative ICH. Immediate hematoma evacuation may be effective in preventing devastating outcomes after postoperative ICH.Copyright © 2018 Elsevier Inc. All rights reserved.

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