Inhalational Anesthesia Reduced Transient Neurological Events After Revascularization Surgery for Moyamoya Disease.
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
18 Dec 2023
18 Dec 2023
Historique:
received:
14
08
2023
accepted:
02
11
2023
medline:
18
12
2023
pubmed:
18
12
2023
entrez:
18
12
2023
Statut:
aheadofprint
Résumé
The choice between inhalational and total intravenous anesthesia (TIVA) in revascularization surgery for Moyamoya disease (MMD) remains a topic of debate. Anesthesia methods have changed with the advent of new anesthetics. This study investigated whether modern anesthesia methods affected the development of neurological symptoms after revascularization surgery for MMD. This single-center retrospective study included 63 adult patients (82 hemispheres) with MMD treated with direct and indirect bypass surgeries at our hospital between 2013 and 2022. Patients were divided into inhalational anesthesia (IA) and TIVA groups based on the anesthesia maintenance method. Baseline patient characteristics; postoperative neurological symptoms, including hyperperfusion syndrome, cerebral infarction, and transient neurological events (TNEs); and cortical hyperintensity belt (CHB) sign scores (5-point scale from 0 to 4) on postoperative magnetic resonance imaging were compared between the two groups. The operation methods, anesthetics, and intraoperative hemodynamic and ventilatory parameters were compared between patients with and without TNEs. The IA and TIVA groups comprised 39 and 43 hemispheres, respectively. The frequency of postoperative hyperperfusion syndrome and cerebral infarction did not differ between the groups, but the number of TNEs in the IA group (5/39; 13%) was significantly lower than that in the TIVA group (16/43; 37%). Multivariate logistic regression analysis revealed that TNEs were associated with TIVA (odds ratio, 3.91; 95% CI, 1.24-12.35; P = .02). The median [IQR] postoperative CHB sign score in the IA group (2 [1-3]) was significantly lower than that in the TIVA group (4 [3-4]). The IA group had fewer postoperative TNEs and lower CHB sign scores than the TIVA group. Although further studies are needed, this study provides insights into the prevention of TNEs with IA and reconsideration of the optimal anesthesia for MMD.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
The choice between inhalational and total intravenous anesthesia (TIVA) in revascularization surgery for Moyamoya disease (MMD) remains a topic of debate. Anesthesia methods have changed with the advent of new anesthetics. This study investigated whether modern anesthesia methods affected the development of neurological symptoms after revascularization surgery for MMD.
METHODS
METHODS
This single-center retrospective study included 63 adult patients (82 hemispheres) with MMD treated with direct and indirect bypass surgeries at our hospital between 2013 and 2022. Patients were divided into inhalational anesthesia (IA) and TIVA groups based on the anesthesia maintenance method. Baseline patient characteristics; postoperative neurological symptoms, including hyperperfusion syndrome, cerebral infarction, and transient neurological events (TNEs); and cortical hyperintensity belt (CHB) sign scores (5-point scale from 0 to 4) on postoperative magnetic resonance imaging were compared between the two groups. The operation methods, anesthetics, and intraoperative hemodynamic and ventilatory parameters were compared between patients with and without TNEs.
RESULTS
RESULTS
The IA and TIVA groups comprised 39 and 43 hemispheres, respectively. The frequency of postoperative hyperperfusion syndrome and cerebral infarction did not differ between the groups, but the number of TNEs in the IA group (5/39; 13%) was significantly lower than that in the TIVA group (16/43; 37%). Multivariate logistic regression analysis revealed that TNEs were associated with TIVA (odds ratio, 3.91; 95% CI, 1.24-12.35; P = .02). The median [IQR] postoperative CHB sign score in the IA group (2 [1-3]) was significantly lower than that in the TIVA group (4 [3-4]).
CONCLUSION
CONCLUSIONS
The IA group had fewer postoperative TNEs and lower CHB sign scores than the TIVA group. Although further studies are needed, this study provides insights into the prevention of TNEs with IA and reconsideration of the optimal anesthesia for MMD.
Identifiants
pubmed: 38108408
doi: 10.1227/neu.0000000000002804
pii: 00006123-990000000-01002
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © Congress of Neurological Surgeons 2023. All rights reserved.
Références
Suzuki J, Takaku A. Cerebrovascular “Moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol. 1969;20(3):288-299.
Kuroda S, Fujimura M, Takahashi J, et al. Diagnostic criteria for Moyamoya disease—2021 revised version. Neurol Med Chir (Tokyo). 2022;62(7):307-312.
Kuroda S, Houkin K. Moyamoya disease: current concepts and future perspectives. Lancet Neurol. 2008;7(11):1056-1066.
Miyamoto S, Yoshimoto T, Hashimoto N, et al. Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial. Stroke. 2014;45(5):1415-1421.
Fujimura M, Shimizu H, Inoue T, Mugikura S, Saito A, Tominaga T. Significance of focal cerebral hyperperfusion as a cause of transient neurologic deterioration after extracranial-intracranial bypass for moyamoya disease: comparative study with non-moyamoya patients using N-isopropyl-p-[(123)I]iodoamphetamine single-photon emission computed tomography. Neurosurgery. 2011;68(4):957-964; discussion 964-965.
Hayashi T, Shirane R, Fujimura M, Tominaga T. Postoperative neurological deterioration in pediatric moyamoya disease: watershed shift and hyperperfusion. J Neurosurg Pediatr. 2010;6(1):73-81.
Heros RC, Scott RM, Kistler JP, Ackerman RH, Conner ES. Temporary neurological deterioration after extracranial-intracranial bypass. Neurosurgery. 1984;15(2):178-185.
Kaku Y, Iihara K, Nakajima N, et al. Cerebral blood flow and metabolism of hyperperfusion after cerebral revascularization in patients with moyamoya disease. J Cereb Blood Flow Metab. 2012;32(11):2066-2075.
Baykan N, Ozgen S, Ustalar ZS, Dagçinar A, Ozek MM. Moyamoya disease and anesthesia. Paediatric Anaesth. 2005;15(12):1111-1115.
Culebras X, Martin JB, Treggiari-Venzi M, Ruefenacht D, Habre W. Propofol increased cerebral perfusion as compared with isoflurane during a cerebral angiography in a child with moyamoya disease. J Neurosurg Anesthesiol. 2003;15(1):50-54.
Kikuta K, Takagi Y, Nozaki K, et al. Effects of intravenous anesthesia with propofol on regional cortical blood flow and intracranial pressure in surgery for moyamoya disease. Surg Neurol. 2007;68(4):421-424.
Sakamoto T, Kawaguchi M, Kurehara K, Kitaguchi K, Furuya H, Karasawa J. Risk factors for neurologic deterioration after revascularization surgery in patients with moyamoya disease. Anesth Analg. 1997;85(5):1060-1065.
Sato K, Shirane R, Kato M, Yoshimoto T. Effect of inhalational anesthesia on cerebral circulation in Moyamoya disease. J Neurosurg Anesthesiol. 1999;11(1):25-30.
Avidan MS, Jacobsohn E, Glick D, et al. Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med. 2011;365(7):591-600.
Gan TJ, Belani KG, Bergese S, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2020;131(2):411-448.
Hamano E, Kataoka H, Morita N, et al. Clinical implications of the cortical hyperintensity belt sign in fluid-attenuated inversion recovery images after bypass surgery for moyamoya disease. J Neurosurg. 2017;126(1):1-7.
Czabanka M, Peña-Tapia P, Schubert GA, et al. Proposal for a new grading of Moyamoya disease in adult patients. Cerebrovasc Dis. 2011;32(1):41-50.
Uda K, Araki Y, Muraoka S, et al. Intraoperative evaluation of local cerebral hemodynamic change by indocyanine green videoangiography: prediction of incidence and duration of postoperative transient neurological events in patients with moyamoya disease. J Neurosurg. 2018;130(4):1367-1375.
Lenz C, Frietsch T, Fütterer C, et al. Local coupling of cerebral blood flow to cerebral glucose metabolism during inhalational anesthesia in rats: desflurane versus isoflurane. Anesthesiology. 1999;91(6):1720-1723.
Lenz C, Rebel A, van Ackern K, Kuschinsky W, Waschke KF. Local cerebral blood flow, local cerebral glucose utilization, and flow-metabolism coupling during sevoflurane versus isoflurane anesthesia in rats. Anesthesiology. 1998;89(6):1480-1488.
Sakata K, Kito K, Fukuoka N, Nagase K, Tanabe K, Iida H. Cerebrovascular reactivity to hypercapnia during sevoflurane or desflurane anesthesia in rats. Korean J Anesthesiol. 2019;72(3):260-264.
Mielck F, Stephan H, Buhre W, Weyland A, Sonntag H. Effects of 1 MAC desflurane on cerebral metabolism, blood flow and carbon dioxide reactivity in humans. Br J Anaesth. 1998;81(2):155-160.
Iwama T, Hashimoto N, Yonekawa Y. The relevance of hemodynamic factors to perioperative ischemic complications in childhood moyamoya disease. Neurosurgery. 1996;38(6):1120-1125; discussion 1125-1126.
Kashiwazaki D, Akioka N, Kuwayama N, et al. Berlin grading system can stratify the onset and predict perioperative complications in adult moyamoya disease. Neurosurgery. 2017;81(6):986-991.
Fujimura M, Watanabe M, Narisawa A, Shimizu H, Tominaga T. Increased expression of serum Matrix Metalloproteinase-9 in patients with moyamoya disease. Surg Neurol. 2009;72(5):476-480; discussion 480.
Kaku Y, Iihara K, Nakajima N, et al. The leptomeningeal ivy sign on fluid-attenuated inversion recovery images in moyamoya disease: positron emission tomography study. Cerebrovasc Dis. 2013;36(1):19-25.
Maeda M, Tsuchida C. “Ivy sign” on fluid-attenuated inversion-recovery images in childhood moyamoya disease. AJNR Am J Neuroradiol. 1999;20(10):1836-1838.
Takemoto Y, Kawano T, Ohmori Y, et al. Hemodynamic study about cortical hyperintensity belt sign after direct bypass surgery for moyamoya disease. J Clin Neurosci. 2020;74:124-129.
Ong B, Bergin P, Heffernan T, Stuckey S. Transient seizure-related MRI abnormalities. J Neuroimaging. 2009;19(4):301-310.
Narducci A, Yasuyuki K, Onken J, Blecharz K, Vajkoczy P. In vivo demonstration of blood-brain barrier impairment in Moyamoya disease. Acta Neurochir (Wien). 2019;161(2):371-378.
Bang OY, Fujimura M, Kim SK. The pathophysiology of Moyamoya disease: an update. J Stroke. 2016;18(1):12-20.
Morimoto T, Enmi JI, Hattori Y, et al. Dysregulation of RNF213 promotes cerebral hypoperfusion. Sci Rep. 2018;8(1):3607.
Remsen LG, Pagel MA, McCormick CI, Fiamengo SA, Sexton G, Neuwelt EA. The influence of anesthetic choice, PaCO2, and other factors on osmotic blood-brain barrier disruption in rats with brain tumor xenografts. Anesth Analg. 1999;88(3):559-567.
Hughes JM, Neese OR, Bieber DD, et al. The effects of propofol on a human in vitro blood-brain barrier model. Front Cell Neurosci. 2022;16:835649.
TerRiet MF, DeSouza GJ, Jacobs JS, et al. Which is most pungent: isoflurane, sevoflurane or desflurane? Br J Anaesth. 2000;85(2):305-307.
Eger EI 2nd. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake. Anesth Analg. 2001;93(4):947-953.