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Updated: Feb 4, 2026

Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
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Preoperative local hemodynamics predict cerebral hyperperfusion syndrome after direct bypass for moyamoya disease: a

Jiatong Zhang1,2, Lu Wang2,3, Yi Wang1,2

  • 1Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China.

Frontiers in Neurology
|February 2, 2026
PubMed

Insights

Postoperative cerebral hyperperfusion syndrome (CHS) after bypass for moyamoya disease (MMD) is predicted by advanced Suzuki stage and lower posterior cerebral artery (PCA) time to peak (Tmax). Quantitative CT perfusion analysis aids in risk stratification for MMD patients.

Area of Science:

  • Neurosurgery
  • Neurology
  • Radiology

Background:

  • Cerebral hyperperfusion syndrome (CHS) is a significant risk after extracranial-intracranial (EC-IC) bypass for moyamoya disease (MMD).
  • Identifying preoperative predictors of CHS is crucial for patient management.

Purpose of the Study:

  • To identify preoperative hemodynamic predictors of CHS using quantitative whole-brain CT perfusion (WB-CTP) analysis.
  • To assess the predictive performance of these factors for CHS after EC-IC bypass in MMD patients.

Main Methods:

  • Retrospective analysis of 103 hemispheres from 89 MMD patients who underwent direct bypass.
  • Preoperative WB-CTP analysis quantifying cerebral blood flow (CBF) and time to peak (Tmax) based on Alberta Stroke Program Early CT score (ASPECTS) topography.
  • Logistic regression and receiver operating characteristic (ROC) analysis to identify independent predictors and evaluate predictive performance.

Main Results:

  • Postoperative CHS occurred in 11.7% of cases.
  • Advanced Suzuki stage and lower posterior cerebral artery (PCA) Tmax were identified as independent predictors of CHS.
  • A combination of Suzuki stage and PCA Tmax achieved an AUC of 0.83 for CHS prediction.

Conclusions:

  • Advanced Suzuki stage and reduced PCA Tmax are independent risk factors for postoperative CHS in MMD patients undergoing direct bypass.
  • Preoperative ASPECTS-based quantitative CTP analysis can effectively stratify CHS risk.
  • This analysis supports individualized surgical planning and perioperative management for MMD patients.
Abstract

Keywords:
ASPECTS topographyCT perfusionEC-IC bypasscerebral hyperperfusion syndromecomplicationsmoyamoya diseaserisk factors

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