| Prognostic factors associated with perioperative ischemic complications in adult-onset moyamoya disease. | |
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MedLine Citation:
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PMID: 20373117 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: To clarify the risk factors associated with perioperative ischemic complications in adult-onset moyamoya disease. MATERIAL AND METHODS: The incidence and causes of perioperative ischemic complications in adult-onset moyamoya disease were retrospectively examined by reviewing 165 surgically treated adult patients. Two hundred forty-six revascularization procedures were performed in these patients. RESULTS: There were 19 (7.7%) perioperative ischemic complications (four infarctions with neurological sequelae and 15 reversible ischemic neurological deficits with a new lesion). The complications occurred in the initially affected hemispheres in 17 (89.4%) of the 19 ischemic complications, regardless of the side of the operation. Multiple ischemic episodes (defined as over four-symptom episodes before treatment), the presence of a preoperative low density area (LDA) on computed tomographic (CT) scanning, and a high signal intensity on diffusion-weighted magnetic resonance (MR) imaging were significantly correlated with perioperative ischemic complications (p < 0.05, p < 0.05, and p < 0.01, respectively). Non-surgical hemodynamic risk factors, i.e., hypercapnia, hypocapnia, or hypotension/hypovolemia, were noted in all of the 19 cases. None of the surgical factors evaluated were associated with the complications identified. CONCLUSIONS: Avoidance of non-surgical hemodynamic risk factors as well as maintaining vital collateral vessels is essential for the prevention of perioperative hemodynamic brain damage in patients with adult-onset moyamoya disease. In addition, very close monitoring of the perioperative care of patients with preoperative multiple ischemic episodes and an LDA or high signal intensity on preoperative CT or diffusion-weighted MR imaging is extremely important. |
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Authors:
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Seung-Jae Hyun; Jong-Soo Kim; Seung-Chyul Hong |
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Publication Detail:
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Type: Journal Article Date: 2010-04-07 |
Journal Detail:
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Title: Acta neurochirurgica Volume: 152 ISSN: 0942-0940 ISO Abbreviation: Acta Neurochir (Wien) Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-06-18 Completed Date: 2011-01-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0151000 Medline TA: Acta Neurochir (Wien) Country: Austria |
Other Details:
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Languages: eng Pagination: 1181-8 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Brain Infarction / etiology, pathology, physiopathology Brain Ischemia / etiology*, pathology, physiopathology Female Humans Male Middle Aged Moyamoya Disease / complications*, physiopathology, surgery* Postoperative Complications / etiology*, pathology, physiopathology Risk Factors Vascular Surgical Procedures / adverse effects*, methods Young Adult |
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