{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T10:25:13Z","timestamp":1794219913122,"version":"4.8.0"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Cerebral hyperperfusion syndrome (CHS) is a complication affecting up to 50% of moyamoya disease (MMD) patients after combined revascularization. The aim of this study was to identify reliable CHS risk factors and develop predictive models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors performed a meta-analysis including studies on both combined and direct revascularization to capture potential risk factors, followed by a sensitivity analysis on the combined bypass group. They also performed a retrospective cohort analysis. Then three models were developed using the derivation cohort and externally validated. Significant variables from meta-analysis and logistic regression were used to construct nomograms, the performance of which was evaluated with receiver operating characteristic curves, calibration, and discrimination analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Meta-analysis identified seven significant risk factors: age (effect 2.17, 95% CI 0.28\u20134.05; p = 0.025), hypertension (risk ratio [RR] 1.42, 95% CI 1.16\u20131.73; p = 0.001), surgery in the dominant hemisphere (RR 1.80, 95% CI 1.55\u20132.10; p &lt; 0.001), preoperative hematocrit (effect 2.50, 95% CI 1.58\u20133.41; p &lt; 0.001), intraoperative high arterial pressure (HAP) (RR 1.78, 95% CI 1.07\u20132.96; p = 0.026), postoperative white blood cell (WBC) count (effect 1.67, 95% CI 0.46\u20132.87; p = 0.007), and cerebral blood flow increase rate (effect 0.80, 95% CI 0.40\u20131.20; p &lt; 0.001). Similar risk factors were confirmed in the retrospective cohort analysis. In a sensitivity analysis focusing on combined revascularization, fewer studies limited inclusion of factors such as temporary occlusion time, intraoperative HAP, postoperative WBC count, and postoperative blood pressure; age and hypertension also lost significance. In the validation cohort, the areas under the curve (AUCs) for model 1 (based on multivariate analysis) and model 2 (based on meta-analysis) were 0.83 (95% CI 0.77\u20130.90) and 0.84 (95% CI 0.77\u20130.91), with Youden indices of 0.54 and 0.53, respectively. Model 3 (based on sensitivity analysis) showed lower performance (AUC 0.76, 95% CI 0.66\u20130.85; Youden index 0.45).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In the meta-analysis and cohort analysis, the authors identified risk factors for CHS following combined revascularization surgery in patients with MMD, and the nomogram constructed based on factors from meta-analysis demonstrated good predictive performance and clinical utility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.12.jns251691","type":"journal-article","created":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T01:51:43Z","timestamp":1778291503000},"page":"397-408","source":"Crossref","is-referenced-by-count":0,"title":["Establishment and external validation of prediction models for risk factors of cerebral hyperperfusion syndrome after combined revascularization in moyamoya disease based on meta-analysis and retrospective cohort studies"],"prefix":"10.3171","volume":"145","author":[{"given":"Linfeng","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peixuan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiping","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanyuan","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Neurol Med Chir (Tokyo)","first-page":"245","article-title":"Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis)","volume":"52","year":"2012","unstructured":"Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis). 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