{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T00:05:14Z","timestamp":1793232314165,"version":"4.5.0"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2010,7]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>Young patients with moyamoya disease frequently exhibit extensive cerebral infarction at the time of initial presentation, and even in the early postoperative period. To investigate clinical characteristics in the early postoperative period, the authors prospectively analyzed findings of MR imaging, MR angiography, and SPECT before and after surgery. The authors focused in particular on how postoperative neurological deterioration occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Between August 2005 and June 2009, 22 patients younger than 18 years of age with moyamoya disease were treated at Miyagi Children's Hospital. The mean patient age (\u00b1 SD) was 8.58 \u00b1 4.55 years (range 2\u201317 years). Superficial temporal artery\u2013middle cerebral artery bypass and indirect bypass of encephalosynangiosis between the brain surface and the temporal muscle, galea, and dura mater were performed in 35 hemispheres. Magnetic resonance imaging and MR angiography were performed before surgery, at 7 days postoperatively, and 3\u20136 months after surgery. A\n                      <jats:sup>123<\/jats:sup>\n                      I-isopropyl iodoamphetamine SPECT scan was also obtained pre- and postoperatively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the postoperative period, neurological deterioration was observed after 15 operations (10 cases of motor paresis, 1 of aphasia, and 4 of sensory disturbance) in 13 patients. All symptoms had resolved by the time of discharge, except in 2 patients who suffered cerebral infarction. All patients exhibited disappearance (94.3%) or reduction (5.7%) of transient ischemic attacks (TIAs) during the follow-up period. Perioperative studies revealed 2 different types of radiological findings, focal uptake decrease on SPECT indicative of cerebral ischemia due to dynamic change in cerebral hemodynamics caused by bypass flow, the so-called watershed shift, and perioperative edematous lesions on MR imaging due to cerebral hyperperfusion. The frequent occurrence of preoperative TIAs was significantly associated with watershed shift, whereas preoperative MR imaging findings and preoperative SPECT findings were not. Age at operation was the only factor significantly associated with postoperative hyperperfusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In young patients, moyamoya disease exhibits rapid progression, resulting in poor clinical outcome. The risk of postoperative neurological deterioration in very young moyamoya patients with frequent TIAs should be noted. The findings in this study showed that direct bypass is not completely safe in patients with moyamoya disease because it causes dynamic change in postoperative cerebral hemodynamics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2010.4.peds09478","type":"journal-article","created":{"date-parts":[[2010,7,1]],"date-time":"2010-07-01T10:03:48Z","timestamp":1277978628000},"page":"73-81","source":"Crossref","is-referenced-by-count":146,"title":["Postoperative neurological deterioration in pediatric moyamoya disease: watershed shift and hyperperfusion"],"prefix":"10.3171","volume":"6","author":[{"given":"Toshiaki","family":"Hayashi","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery, Miyagi Children's Hospital, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reizo","family":"Shirane","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery, Miyagi Children's Hospital, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miki","family":"Fujimura","sequence":"additional","affiliation":[{"name":"Tohoku University Graduate School of Medicine, Sendai, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teiji","family":"Tominaga","sequence":"additional","affiliation":[{"name":"Tohoku University Graduate School of Medicine, Sendai, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0060073","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1159\/000120932","article-title":"Pial synangiosis for moyamoya syndrome in children","volume":"23","author":"Adelson","year":"1995"},{"key":"b2-0060073","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"180","DOI":"10.3171\/jns.1989.71.2.0180","article-title":"Cranial burr hole for revascularization in moyamoya disease","volume":"71","author":"Endo","year":"1989"},{"key":"b3-0060073","series-title":"Neurosurg Rev","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1007\/s10143-009-0184-6","article-title":"Cerebral ischemia owing to compression of the brain by swollen temporal muscle used for encephalo-myo-synangiosis in moyamoya disease","volume":"32","author":"Fujimura","year":"2009"},{"key":"b4-0060073","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1007\/s00381-007-0551-y","article-title":"Efficacy of superficial temporal artery-middle cerebral artery anastomosis with routine postoperative cerebral blood flow measurement during the acute stage in childhood moyamoya disease","volume":"24","author":"Fujimura","year":"2008"},{"key":"b5-0060073","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"E195","DOI":"10.1227\/01.NEU.0000336311.60660.26","article-title":"Additional surgery for postoperative ischemic symptoms in patients with moyamoya disease: the effectiveness of occipital artery-posterior cerebral artery bypass with an indirect procedure: technical case report","volume":"64","author":"Hayashi","year":"2009"},{"key":"b6-0060073","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1227\/00006123-198408000-00006","article-title":"Temporary neurological deterioration after extracranial-intracranial bypass","volume":"15","author":"Heros","year":"1984"},{"key":"b7-0060073","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/S0090-3019(97)82798-X","article-title":"Regional ischemia during cerebral bypass surgery","volume":"47","author":"Hoffman","year":"1997"},{"key":"b8-0060073","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1007\/s003810050034","article-title":"Combined revascularization surgery for childhood moyamoya disease: STA-MCA and encephalo-duro-arterio-myo-synangiosis","volume":"13","author":"Houkin","year":"1997"},{"key":"b9-0060073","series-title":"Childs Nerv Syst","first-page":"734","article-title":"How does angiogenesis develop in pediatric moyamoya disease after surgery? 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