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Apparent Diffusion Coefficient and Transient Neurological Deficit after Revascularization Surgery in Moyamoya Disease
Yoshio Araki1, Yasushi Takagi1, Yasutaka Fushimi2
1Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Background:
Transient neurological deficits are relatively common after direct revascularization surgery for moyamoya disease (MMD). Although recent evidence has revealed the clinical features and pathophysiology, preoperative predictors have remained unclear. This study investigated whether the apparent diffusion coefficient (ADC) in normal-appearing white matter (NAWM) on magnetic resonance imaging could offer a predictor of postoperative transient neurological deficits.
Methods:
This study included adult patients with MMD who underwent superficial temporal artery-middle cerebral artery bypass. Preoperative ADCs were measured in NAWM on ipsilateral hemisphere. Single photon emission computed tomography (SPECT) with (123)I-iodoamphetamine was performed on postoperative days 2-6. Relationships between mean ADC and postoperative transient neurological deficits were assessed.
Results:
Twenty of the 26 subjects (76.9%) experienced transient neurological deficits. Focal hyperemia on postoperative SPECT appeared in 11 of the 20 subjects with postoperative transient neurological deficits and 1 of the 6 subjects without (P = .12). Mean ADCs in patients with and without postoperative transient neurological deficits were 748.3 ± 12 mm(2)/second × 10(-6) and 679.7 ± 21.9 mm(2)/second × 10(-6), respectively (P = .0091).
Conclusions:
Preoperative ADC elevation in NAWM may indicate postoperative transient neurological deficits not only in patients with postoperative hyperemia on SPECT, but also in patients with this pathology.
Insights
Elevated apparent diffusion coefficient (ADC) in normal-appearing white matter (NAWM) before moyamoya disease surgery may predict transient neurological deficits. This finding aids in anticipating postoperative complications.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Transient neurological deficits are common after moyamoya disease (MMD) revascularization.
- Preoperative predictors for these deficits remain unclear.
- Apparent diffusion coefficient (ADC) in normal-appearing white matter (NAWM) is explored as a potential predictor.
Purpose of the Study:
- To investigate if preoperative ADC in NAWM can predict postoperative transient neurological deficits in MMD patients.
- To assess the relationship between ADC values and the occurrence of these deficits.
Main Methods:
- Adult MMD patients undergoing superficial temporal artery-middle cerebral artery bypass were included.
- Preoperative ADCs were measured in ipsilateral NAWM using MRI.
- Postoperative SPECT was performed, and relationships between mean ADC and transient neurological deficits were analyzed.
Main Results:
- 76.9% of patients experienced transient neurological deficits post-surgery.
- Mean ADCs were significantly higher in patients with deficits (748.3 ± 12) compared to those without (679.7 ± 21.9).
- Focal hyperemia on SPECT was observed but not significantly correlated with deficits.
Conclusions:
- Preoperative elevated ADC in NAWM is a potential predictor of postoperative transient neurological deficits in MMD.
- This predictor may be relevant even in the absence of postoperative hyperemia.
