PERIOPERATIVE FACTORS RELATED TO THE DEVELOPMENT OF ISCHEMIC COMPLICATIONS IN PATIENTS WITH MOYAMOYA DISEASE

In purpose of clarifying the risk factors of perioperative ischemic co mplications in cases with moyamoya disease, a retrospective study was conducted on the perioperative care of 36 patients who underwent vascu lar reconstruction for moyamoya disease. Following surgery, 8 patients developed ischemic complications (5 with minor completed strokes and 3 with transient ischemic attacks). Three factors including the presen ce of a preoperative low density area (LDA), intra-operative urinary o utput, and a reduction in the hematocrit significantly differed with c omplications and those without. In an evaluation of individual cases, intra-operative hypercapnia, hypotension, and a reduction in the circu lating blood volume also were identified as potential factors associat ed with complications. On the basis of these findings, it was conclude d that it is necessary to infuse an adequate amount of fluids, maintai n normocapnic and normothermic states, and actively correct anemia in patients undergoing vascular reconstruction for moyamoya disease. It i s also necessary to pay particular attention to perioperative care in patients in whom a LDA is detected by preoperative CT.