Prediction of Cerebral Hyperperfusion Syndrome After Combined Bypass Surgery in Moyamoya Disease Using Hemodynamic and Clinical Data

Purpose: Cerebral hyperperfusion syndrome (CHS) is a postoperative complication in moyamoya disease (MMD). However, limited studies have investigated the association between preoperative hemodynamic features and postoperative CHS. In this study, we aimed to identify the predictors of postoperative CHS in MMD using preoperative hemodynamic and clinical data. Patients and Methods: In this retrospective study, we analyzed data from 72 hemispheres of 56 adult patients with MMD who underwent combined bypass surgery. Hemodynamic features were extracted from the region of interest on preoperative arterial spin-labeling magnetic resonance imaging and basal and acetazolamide-challenged single-photon emission computed tomography (SPECT). The predictive capacity of the hemodynamic features for postoperative CHS was analyzed using a generalized estimating equation. Multivariable analysis was performed using hemodynamic and clinical data. Results: Postoperative CHS occurred in 35 operated hemispheres (48.61%). Univariable analysis revealed that the cerebrovascular reservoir capacity (CVR) in the temporal and frontal cortices on SPECT significantly predicted CHS, with a lower CVR observed in the CHS group ( P <0.050). In multivariable analysis, a lower CVR in the temporal cortex [odds ratio (95% CI), 0.99 [0.98–0.99]; P =0.034], higher preoperative modified Rankin scale score [1.18 (1.05–1.33); P =0.008], and anastomosis at the left hemisphere [1.25 (1.05–1.47); P =0.010] were associated with an increased CHS risk. Conclusions: Low preoperative CVR in the temporal cortex, poor preoperative neurological status, and surgery at dominant hemisphere are potential risk factors for postoperative CHS in MMD.