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

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Title: Postoperative Intracerebral Hemorrhage After Combined Revascularization Surgery in Moyamoya Disease : Profiles and Clinical Associations
Other Titles: Postoperative ICH after combined revascularization surgery in MMD
Authors: Tokairin, Kikutaro Browse this author
Kazumata, Ken Browse this author
Uchino, Haruto Browse this author
Ito, Masaki Browse this author
Ono, Kota Browse this author
Tatezawa, Ryota Browse this author
Shindo, Takafumi Browse this author
Kawabori, Masahito Browse this author →KAKEN DB
Nakayama, Naoki Browse this author →KAKEN DB
Houkin, Kiyohiro Browse this author →KAKEN DB
Keywords: Blood pressure
Cerebral hyperperfusion syndrome
Cerebral revascularization
Hematoma evacuation
Intracerebral hemorrhage
Moyamoya disease
Issue Date: Dec-2018
Publisher: Elsevier
Journal Title: World neurosurgery
Volume: 120
Start Page: E593
End Page: E600
Publisher DOI: 10.1016/j.wneu.2018.08.132
Abstract: OBJECTIVE: In 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. METHODS: The 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. RESULTS: Postoperative ICH was observed in 6 cases (2.99%; mean age, 46.0 +/- 1 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. CONCLUSIONS: The 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.
Rights: © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license
Type: article (author version)
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 東海林 菊太郎

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