| 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 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| Type: | article (author version) |
| URI: | http://hdl.handle.net/2115/76216 |
| 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)
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