Diagnostic values of the "to and fro" conflict sign on intraoperative indocyanine green video angiography as a warning sign of the focal cerebral hyperperfusion and watershed shift phenomenon after STA-MCA bypass for adult patients with Moyamoya disease

Area of Science:

• Neurosurgery
• Vascular Surgery
• Diagnostic Imaging

Background:

• Focal cerebral hyperperfusion (CHP) and watershed shift (WS) phenomenon are potential complications after STA-MCA bypass for Moyamoya disease (MMD).
• These complications can lead to delayed intracerebral hemorrhage and neurological deterioration.
• Preoperative prediction of focal CHP and WS phenomenon is challenging.

Purpose of the Study:

• To assess the diagnostic value of the "to and fro" conflict sign on ICG-VA for predicting focal CHP and WS phenomenon.
• To evaluate the association between the "to and fro" conflict sign and the incidence of focal CHP and WS phenomenon.

Main Methods:

• Ninety-seven adult MMD patients undergoing 106 STA-MCA bypass surgeries were enrolled.
• Quantitative cerebral blood flow (CBF) was analyzed using SPECT preoperatively and postoperatively.
• The presence of the "to and fro" conflict sign on ICG-VA was correlated with the incidence of focal CHP and WS phenomenon.

Main Results:

• The incidence of focal CHP and WS phenomenon was 29.2% and 10.4%, respectively.
• The "to and fro" conflict sign was observed in 35.5% of patients with focal CHP and 54.5% with WS phenomenon.
• A significant association was found between the "to and fro" conflict sign and both focal CHP and WS phenomenon.

Conclusions:

• The "to and fro" conflict sign on ICG-VA is a valuable intraoperative warning sign.
• It aids in the early detection of focal CHP and WS phenomenon after STA-MCA bypass in MMD patients.
• This sign provides neurosurgeons with a tool for improved patient management.