Introduction: The focal cerebral hyperperfusion (CHP) is a potential complication after Superficial temporal artery-middle cerebral artery (STA-MCA) bypass for Moyamoya disease (MMD) that can result in delayed intracerebral hemorrhage and/or neurological deterioration. The focal CHP could accompany hemodynamic ischemia due to the "watershed shift (WS) phenomenon". Preoperative prediction of the focal CHP and WS phenomenon remains challenging. Here, we aimed to assess the diagnostic value of the "to and fro" conflict sign, conflicting blood flow around the vascular territory of the recipient arteries on an indocyanine green video angiography (ICG-VA) for predicting the focal CHP and WS phenomenon.

Methods: Ninety-seven consecutive adult patients with MMD, undergoing 106 surgeries, were enrolled. Serial quantitative analysis of cerebral blood flow (CBF) was routinely conducted using N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography preoperatively and postoperative day 1 and 7 after STA-MCA bypass. The association between the "to and fro" conflict sign on ICG-VA and the focal CHP/WS phenomenon incidence was then analyzed.

Results: The incidence of the fokal CHP and WS phenomenon was 29.2% (31/106) and 10.4% (11/106), respectively. The "to and fro" conflict sign was evident in 35.5% (11/31) and 54.5% (6/11) of MMD patients with the focal CHP and WS phenomenon, respectively. The "to and fro" conflict sign was significantly associated with both the focal CHP and WS phenomenon.

Conclusion: The "to and fro" conflict sign on ICG-VA may serve as an intraoperative warning sign of the focal CHP and WS phenomenon after STA-MCA bypass in adult patients with MMD, providing neurosurgeons with a valuable tool for early detection.

The Author(s). Published by S. Karger AG, Basel.

简介： 焦点脑过度灌注（CHP）是烟雾病（MMD）患者进行颞浅动脉-大脑中动脉（STA-MCA）搭桥术后的一种潜在并发症，可能导致迟发性脑内出血和/或神经功能恶化。焦点 CHP 可能伴有由于“流域偏移 (WS) 现象”引起的血流动力学缺血。术前预测焦点 CHP 和 WS 现象仍然具有挑战性。在这里，我们旨在评估“来回冲突”征象在吲哚菁绿视频血管造影（ICG-VA）中的诊断价值，该征象表现为供体动脉血管区域周围的血流冲突，以预测焦点 CHP 和 WS 现象。

方法： 共纳入97例连续成年烟雾病患者进行106次手术。术前和术后第1天及第7天常规使用N-异丙基-p-[¹²³I]碘氨苯胺单光子发射计算机断层扫描（SPECT）定量分析脑血流(CBF)。然后分析ICG-VA上的“来回冲突”征象与焦点 CHP/WS 现象发生率之间的关联。

结果： 焦点 CHP 和 WS 现象的发生率为29.2%（31/106）和10.4%（11/106）。在伴有焦点 CHP 和 WS 现象的MMD患者中，“来回冲突”征象分别出现在35.5%（11/31）和54.5%（6/11）的患者中。“来回冲突”征象与焦点 CHP 和 WS 现象显著相关。

结论： ICG-VA上的“来回冲突”征象可能在STA-MCA搭桥术后为成年烟雾病患者的焦点 CHP 和 WS 现象提供术中预警信号，为神经外科医生提供了早期检测的宝贵工具。