Postoperative Basal Ganglia-Dominant Perfusion Pattern Predicts Lower Risk of Transient Neurological Events After...

Area of Science:

• Neurosurgery
• Neurology
• Radiology

Background:

• Transient neurological events are common after direct revascularization for moyamoya disease (MMD).
• Understanding early postoperative perfusion changes is crucial for predicting neurological outcomes.
• SPECT imaging can reveal perfusion redistribution patterns.

Purpose of the Study:

• To investigate the association between early postoperative perfusion redistribution on SPECT and transient neurological events after MMD revascularization.
• To determine if basal ganglia versus cortical perfusion balance predicts neurological stability.

Main Methods:

• Retrospective analysis of 78 hemispheres from 61 MMD patients undergoing superficial temporal artery-MCA bypass.
• N-Isopropyl-p-[¹²³I]iodoamphetamine SPECT performed preoperatively and on postoperative day 1.
• Calculation of relative cerebral blood flow (CBF) ratios and a balance index (basal ganglia to anterior MCA territory CBF ratio).

Main Results:

• Transient neurological events occurred in 21.8% of hemispheres.
• Higher postoperative basal ganglia relative CBF ratio and a higher balance index were associated with fewer neurological events (P < 0.002).
• A balance index cutoff of 1.052 predicted transient neurological events with 82.0% specificity and 76.5% sensitivity.

Conclusions:

• Postoperative basal ganglia-dominant perfusion is linked to neurological stability after MMD revascularization.
• This perfusion pattern is associated with a reduced risk of transient neurological events.
• SPECT-derived perfusion balance index may serve as a predictive marker for postoperative neurological outcomes.