Analysis Of Risk Factors Of Hyperperfusion Syndrome After Superficial Temporal Artery-middle Cerebral Artery Bypass Grafting In The Treatment Of Moyamoya Disease

Objective: To explore the risk factors of hyperperfusion syndrome after superficial temporal artery-middle cerebral artery bypass grafting in the treatment of moyamoya disease.Methods:1.71 patients with moyamoya disease diagnosed by digital subtraction angiography in the Department of Neurosurgery of the second Hospital of Hebei Medical University from August 2019 to December 2020 were studied.Admission to improve the relevant examination and laboratory tests,it is clear that there are surgical indications and no surgical contraindications,so superficial temporal artery-middle cerebral artery bypass surgery was performed.On the first day after operation,all patients underwent cranial computed tomography((Computed tomography,CT),)to determine the local cerebral perfusion and to determine whether there was acute cerebral hemorrhage and cerebral infarction after operation.CT perfusion imaging(CT Perfusion imaging,CTP),was used to evaluate the cerebral blood flow before and after operation in all patients at admission and 1 week after operation.At the same time,in order to evaluate the patency of the bridged vessels,all patients were examined by CT angiography and(CT angiography,CTA)1week after operation.2.The above clinical data were summarized as follows:(1)Counting data: sex,surgical side,history of smoking and drinking,history of basic diseases(hypertension,coronary heart disease and diabetes),type of disease(ischemic type,hemorrhagic type);(2)measurement data: age,preoperative and postoperative cerebral blood flow((Cerebral blood flow,CBF).The patients were classified according to the types of postoperative complications,and combined with the previous literature,the risk factors that may be hyperperfusion syndrome were analyzed.Statistical methods use SPSS 23.0for data analysis,measurement data:measurement data in accordance with normal distribution,expressed by(x ±s),compared with t-test;measurement data that do not conform to normal distribution,expressed by median(quartile)[M(P25.P75)],compared with Wilcoxon symbolic rank test.Chi-square test was used for counting data,Fisher’s accurate test was used when the frequency of a certain item was less than 1,and correction formula was used when the frequency of an item was less than 5.The difference was statistically significant.Results: A total of 71 patients with moyamoya disease who underwent superficial temporal artery-middle cerebral artery bypass surgery in the Department of Neurosurgery of the second Hospital of Hebei Medical University were included,including 36 males and 35 females.The age ranged from 7 to 70 years old,and the average age was 40.8 ±11.6 years old.Surgical side: 36 cases were operated on the left side and 35 cases were operated on the right side.In the aspect of basic diseases,there were 31 cases of hypertension,5 cases of diabetes and 4 cases of hypertension with diabetes.Postoperative complications: the overall complication rate was 18.3%,1 case of new cerebral infarction(1.4%),12 cases of hyperperfusion syndrome(16.9%),2 cases of epileptic seizures,2 cases of speech disorder,1 case of poor speech and poor wound healing,6 cases of headache and 1 case of headache with subcutaneous effusion.Conclusions:The risk factors of hyperperfusion syndrome were hypertension history,postoperative CBF and surgical side.Among them,postoperative CBF and surgical side were independent risk factors.