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

Tokairin, Kikutaro; Kazumata, Ken; Uchino, Haruto; Ito, Masaki; Ono, Kota; Tatezawa, Ryota; Shindo, Takafumi; Kawabori, Masahito; Nakayama, Naoki; Houkin, Kiyohiro

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

Tokairin, Kikutaro; Kazumata, Ken; Uchino, Haruto et al.

World neurosurgery, 2018, 120, E593-E600

Permalink : https://hdl.handle.net/2115/76216

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アクセス権	open access
URI	https://hdl.handle.net/2115/76216
タイトル	Postoperative Intracerebral Hemorrhage After Combined Revascularization Surgery in Moyamoya Disease : Profiles and Clinical Associations
その他のタイトル	Postoperative ICH after combined revascularization surgery in MMD
著者	Tokairin, Kikutaro ; Kazumata, Ken ; Uchino, Haruto ; Ito, Masaki ; Ono, Kota ; Tatezawa, Ryota ; Shindo, Takafumi ; Kawabori, Masahito ; Nakayama, Naoki ; Houkin, Kiyohiro
著者名 Tokairin, Kikutaro
著者名 Kazumata, Ken
著者名 Uchino, Haruto
著者名 Ito, Masaki
著者名 Ono, Kota
著者名 Tatezawa, Ryota
著者名 Shindo, Takafumi
e-Rad_Researcher 50399870 著者名 Kawabori, Masahito
e-Rad_Researcher 40421961 著者名 Nakayama, Naoki
e-Rad_Researcher 90229146 著者名 Houkin, Kiyohiro
言語	英語
キーワード	Blood pressure
	Cerebral hyperperfusion syndrome
	Cerebral revascularization
	Hematoma evacuation
	Intracerebral hemorrhage
	Moyamoya disease
発行日	2018-12
出版者	Elsevier
収録物名	World neurosurgery
巻(号)	120
ページ	E593-E600
抄録	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.
資源タイプ	学術雑誌論文
出版タイプ	Accepted Manuscript
権利情報	Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
権利情報	© 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/
PISSN	1878-8750
関連情報 (isVersionOf)	出版社版DOI https://doi.org/10.1016/j.wneu.2018.08.132