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Objective Superficial temporal artery–middle cerebral artery anastomosis is an established treatment for moyamoya disease. However, hemorrhagic cerebral hyperperfusion syndrome (CHS) leads to poor outcomes. This study aimed to identify predictors of hemorrhagic CHS based on regional cerebral blood flow (rCBF) in patients with moyamoya disease. Methods The study included 251 hemispheres in 155 patients with moyamoya disease who underwent preoperative and postoperative rCBF measurements and superficial temporal artery–middle cerebral artery double anastomosis. We used rCBF increase rate for predicting hemorrhagic CHS. rCBF increase rate was calculated by 2 methods. In method 1, the rCBF value on the operated side was compared with the rCBF value on the nonoperated side. In method 2, the postoperative rCBF value on the operated side was compared with the preoperative rCBF value on the operated side. Patients were classified into 4 groups according to rCBF increase rate to predict risk of hemorrhagic CHS. Results Hemorrhagic CHS occurred in 7 (2.8%) hemispheres (no children). Severe hemorrhagic CHS occurred in only 1 (0.4%) hemisphere. Hemorrhagic CHS was observed in patients with ≥30% rCBF increase according to method 1 and ≥50% rCBF increase according to method 2 and was most frequently noted in ≥100% rCBF increase. Conclusions Predictors for hemorrhagic CHS were ≥30% rCBF increase when using method 1 and ≥50% increase when using method 2. Highlights • Hemorrhagic CHS leads to poor outcomes; we identify predictors of hemorrhagic CHS based on rCBF. • We used 2 methods to calculate rCBF increase rate (method 1 and method 2). • Hemorrhagic CHS occurred in 7 of 251 (2.8%) hemispheres. • Predictors for hemorrhagic CHS were ≥30% rCBF increase (method 1) and ≥50% increase (method 2). [ABSTRACT FROM AUTHOR]

Objective Postoperative hyperperfusion is an important complication after direct bypass for moyamoya disease, which sometimes occurs late after initial postoperative cerebral blood flow (CBF) measurement. This study aimed to clarify the incidence of hyperperfusion with management using postoperative continuous sedation and repeated postoperative CBF measurement and to identify factors associated with delayed hyperperfusion. Methods This retrospective study evaluated 72 consecutive hemispheres in 56 adult Japanese patients with moyamoya disease who underwent direct bypass. Postoperative continuous sedation was routinely administered based on CBF evaluation. First, the incidence of symptomatic hyperperfusion was investigated. Second, radiologic hyperperfusion (RHP), which was strictly defined as >30% increase in CBF compared with the contralateral side, and factors associated with delayed RHP were statistically analyzed. Results Postoperative symptomatic hyperperfusion occurred in 3 hemispheres (4.2%), including subarachnoid hemorrhage in 1 hemisphere (1.4%). RHP immediately after surgery was identified in 16 hemispheres (22.2%). In 8 hemispheres (11.1%), RHP appeared or worsened several days after initial CBF study. In univariate logistic regression analysis, decreased preoperative cerebral vasoreactivity was significantly associated with delayed RHP. Conclusions The incidence of symptomatic hyperperfusion was 4.2% with management. Delayed hyperperfusion was significantly associated with decreased cerebral vasoreactivity. Therefore, repeated CBF measurements evaluating preoperative cerebral vasoreactivity may decrease complications. Highlights • Hyperperfusion is an important complication after direct bypass for MMD. • Hyperperfusion sometimes occurs late after initial postoperative CBF measurement. • Delayed hyperperfusion was significantly associated with decreased CVR. • Repeated CBF measurements evaluating preoperative CVR may decrease complications. [ABSTRACT FROM AUTHOR]