{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:11:23Z","timestamp":1770351083746,"version":"3.49.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T00:00:00Z","timestamp":1711324800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,25]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Local vasogenic edema induced after direct revascularization in moyamoya disease (MMD) is associated with blood\u2013brain barrier dysfunction, potentially leading to postoperative cerebral hyperperfusion (CHP) or delayed intracerebral hemorrhage. This phenomenon allows the leakage of fluids, proteins, and other substances from the blood vessels into the extracellular compartment. Typically, such edema is observed postoperatively rather than intraoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 48-year-old female with ischemic-onset MMD underwent revascularization on her left hemisphere with Suzuki\u2019s angiographic stage III. Direct bypass was successfully performed, as confirmed by intravenous indocyanine green (ICG) video angiography. Subsequently, ICG extravasation was observed near the anastomosis site, despite the absence of cortical injury or bleeding under white light microscopy. Postoperative radiological imaging showed reversible pure vasogenic edema in the corresponding area, with no evidence of CHP. The patient did not exhibit neurological deterioration and was discharged home on postoperative day 16.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>ICG, characterized by low molecular weight, water solubility, and high affinity with plasma proteins, can extravasate, serving as a direct indication of local vasogenic edema induced by direct revascularization in MMD. To enhance comprehension of the vulnerability of the blood\u2013brain barrier in MMD, it is advisable to gather cases with prolonged observations of ICG video angiography after direct revascularization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case2465","type":"journal-article","created":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T02:19:29Z","timestamp":1711333169000},"source":"Crossref","is-referenced-by-count":1,"title":["Impact of intraoperative cortical indocyanine green extravasation on local vasogenic edema immediately after direct revascularization in an adult with moyamoya disease: illustrative case"],"prefix":"10.3171","volume":"7","author":[{"given":"Maeho","family":"Yamasaki","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haruto","family":"Uchino","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taku","family":"Sugiyama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miki","family":"Fujimura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Arch Neurol.","first-page":"288","article-title":"Cerebrovascular \u201cmoyamoya\u201d disease. Disease showing abnormal net-like vessels in base of brain","volume":"20","author":"Suzuki J","year":"1969","unstructured":"Suzuki J, Takaku A Cerebrovascular \u201cmoyamoya\u201d disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol. 1969;20(3):288\u2013299."},{"issue":"7","key":"b2","series-title":"Neurol Med Chir (Tokyo).","first-page":"307","article-title":"Diagnostic criteria for moyamoya disease \u2013 2021 revised version","volume":"62","author":"Kuroda S","year":"2022","unstructured":"Kuroda S, Fujimura M, Takahashi J,  Diagnostic criteria for moyamoya disease \u2013 2021 revised version. Neurol Med Chir (Tokyo). 2022;62(7):307\u2013312."},{"issue":"3","key":"b3","series-title":"J Neurosurg.","first-page":"793","article-title":"Meta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults","volume":"128","author":"Jeon JP","year":"2018","unstructured":"Jeon JP, Kim JE, Cho WS, Bang JS, Son YJ, Oh CW Meta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults. J Neurosurg. 2018;128(3):793\u2013799."},{"issue":"5","key":"b4","series-title":"Stroke.","first-page":"1415","article-title":"Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial","volume":"45","author":"Miyamoto S","year":"2014","unstructured":"Miyamoto S, Yoshimoto T, Hashimoto N,  Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial. Stroke. 2014;45(5): 1415\u20131421."},{"issue":"4","key":"b5","series-title":"Neurol Med Chir (Tokyo).","first-page":"165","article-title":"2021 Japanese guidelines for the management of moyamoya disease: guidelines from the Research Committee on Moyamoya Disease and Japan Stroke Society","volume":"62","author":"Fujimura M","year":"2022","unstructured":"Fujimura M, Tominaga T, Kuroda S,  2021 Japanese guidelines for the management of moyamoya disease: guidelines from the Research Committee on Moyamoya Disease and Japan Stroke Society. Neurol Med Chir (Tokyo). 2022;62(4):165\u2013170."},{"issue":"3","key":"b6","series-title":"Surg Neurol.","first-page":"273","article-title":"Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease","volume":"67","author":"Fujimura M","year":"2007","unstructured":"Fujimura M, Kaneta T, Mugikura S, Shimizu H, Tominaga T Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease. Surg Neurol. 2007;67(3):273\u2013282."},{"issue":"2","key":"b7","series-title":"Surg Neurol.","first-page":"223","article-title":"Delayed intracerebral hemorrhage after superficial temporal artery-middle cerebral artery anastomosis in a patient with moyamoya disease: possible involvement of cerebral hyperperfusion and increased vascular permeability","volume":"71","author":"Fujimura M","year":"2009","unstructured":"Fujimura M, Shimizu H, Mugikura S, Tominaga T Delayed intracerebral hemorrhage after superficial temporal artery-middle cerebral artery anastomosis in a patient with moyamoya disease: possible involvement of cerebral hyperperfusion and increased vascular permeability. 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Stroke. 2016;47(7):1930\u20131932."},{"issue":"7","key":"b13","series-title":"J Stroke Cerebrovasc Dis.","first-page":"e179","article-title":"Local vasogenic edema without cerebral hyperperfusion after direct revascularization surgery for moyamoya disease","volume":"24","author":"Sakata H","year":"2015","unstructured":"Sakata H, Fujimura M, Mugikura S, Sato K, Tominaga T Local vasogenic edema without cerebral hyperperfusion after direct revascularization surgery for moyamoya disease. J Stroke Cerebrovasc Dis. 2015;24(7):e179\u2013e184."},{"issue":"1","key":"b14","series-title":"J Neurosurg.","first-page":"1","article-title":"Clinical implications of the cortical hyperintensity belt sign in fluid-attenuated inversion recovery images after bypass surgery for moyamoya disease","volume":"126","author":"Hamano E","year":"2017","unstructured":"Hamano E, Kataoka H, Morita N,  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\u20137."},{"issue":"8","key":"b15","series-title":"J Stroke Cerebrovasc Dis.","first-page":"e172","article-title":"Paradoxical association of symptomatic local vasogenic edema with global cerebral hypoperfusion after direct revascularization surgery for adult moyamoya disease","volume":"27","author":"Tashiro R","year":"2018","unstructured":"Tashiro R, Fujimura M, Mugikura S,  Paradoxical association of symptomatic local vasogenic edema with global cerebral hypoperfusion after direct revascularization surgery for adult moyamoya disease. J Stroke Cerebrovasc Dis. 2018;27(8):e172\u2013e176."},{"issue":"4","key":"b16","series-title":"J Stroke Cerebrovasc Dis.","first-page":"104625","article-title":"Persistent local vasogenic edema with dynamic change in the regional cerebral blood flow after STA-MCA bypass for adult moyamoya disease","volume":"29","author":"Kawamura K","year":"2020","unstructured":"Kawamura K, Fujimura M, Tashiro R, Kanoke A, Saito A, Tominaga T Persistent local vasogenic edema with dynamic change in the regional cerebral blood flow after STA-MCA bypass for adult moyamoya disease. J Stroke Cerebrovasc Dis. 2020;29(4):104625."},{"issue":"1","key":"b17","series-title":"Neurosurg Rev.","first-page":"119","article-title":"Association of RNF213 polymorphism and cortical hyperintensity sign on fluid-attenuated inversion recovery images after revascularization surgery for moyamoya disease: possible involvement of intrinsic vascular vulnerability","volume":"46","author":"Uchino H","year":"2023","unstructured":"Uchino H, Ito M, Tokairin K,  Association of RNF213 polymorphism and cortical hyperintensity sign on fluid-attenuated inversion recovery images after revascularization surgery for moyamoya disease: possible involvement of intrinsic vascular vulnerability. Neurosurg Rev. 2023;46(1):119."},{"issue":"2","key":"b18","series-title":"Acta Neurochir (Wien).","first-page":"371","article-title":"In vivo demonstration of blood-brain barrier impairment in moyamoya disease","volume":"161","author":"Narducci A","year":"2019","unstructured":"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\u2013378."},{"issue":"7","key":"b19","series-title":"Invest Ophthalmol Vis Sci.","first-page":"1286","article-title":"Binding properties of indocyanine green in human blood","volume":"39","author":"Yoneya S","year":"1998","unstructured":"Yoneya S, Saito T, Komatsu Y, Koyama I, Takahashi K, Duvoll-Young J Binding properties of indocyanine green in human blood. Invest Ophthalmol Vis Sci. 1998;39(7):1286\u20131290."},{"issue":"3","key":"b1","series-title":"Arch Neurol.","first-page":"288","article-title":"Cerebrovascular \u201cmoyamoya\u201d disease. Disease showing abnormal net-like vessels in base of brain","volume":"20","author":"Suzuki J","year":"1969","unstructured":"Suzuki J, Takaku A Cerebrovascular \u201cmoyamoya\u201d disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol. 1969;20(3):288\u2013299."},{"issue":"7","key":"b2","series-title":"Neurol Med Chir (Tokyo).","first-page":"307","article-title":"Diagnostic criteria for moyamoya disease \u2013 2021 revised version","volume":"62","author":"Kuroda S","year":"2022","unstructured":"Kuroda S, Fujimura M, Takahashi J,  Diagnostic criteria for moyamoya disease \u2013 2021 revised version. Neurol Med Chir (Tokyo). 2022;62(7):307\u2013312."},{"issue":"3","key":"b3","series-title":"J Neurosurg.","first-page":"793","article-title":"Meta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults","volume":"128","author":"Jeon JP","year":"2018","unstructured":"Jeon JP, Kim JE, Cho WS, Bang JS, Son YJ, Oh CW Meta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults. J Neurosurg. 2018;128(3):793\u2013799."},{"issue":"5","key":"b4","series-title":"Stroke.","first-page":"1415","article-title":"Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial","volume":"45","author":"Miyamoto S","year":"2014","unstructured":"Miyamoto S, Yoshimoto T, Hashimoto N,  Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial. Stroke. 2014;45(5): 1415\u20131421."},{"issue":"4","key":"b5","series-title":"Neurol Med Chir (Tokyo).","first-page":"165","article-title":"2021 Japanese guidelines for the management of moyamoya disease: guidelines from the Research Committee on Moyamoya Disease and Japan Stroke Society","volume":"62","author":"Fujimura M","year":"2022","unstructured":"Fujimura M, Tominaga T, Kuroda S,  2021 Japanese guidelines for the management of moyamoya disease: guidelines from the Research Committee on Moyamoya Disease and Japan Stroke Society. Neurol Med Chir (Tokyo). 2022;62(4):165\u2013170."},{"issue":"3","key":"b6","series-title":"Surg Neurol.","first-page":"273","article-title":"Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease","volume":"67","author":"Fujimura M","year":"2007","unstructured":"Fujimura M, Kaneta T, Mugikura S, Shimizu H, Tominaga T Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease. Surg Neurol. 2007;67(3):273\u2013282."},{"issue":"2","key":"b7","series-title":"Surg Neurol.","first-page":"223","article-title":"Delayed intracerebral hemorrhage after superficial temporal artery-middle cerebral artery anastomosis in a patient with moyamoya disease: possible involvement of cerebral hyperperfusion and increased vascular permeability","volume":"71","author":"Fujimura M","year":"2009","unstructured":"Fujimura M, Shimizu H, Mugikura S, Tominaga T Delayed intracerebral hemorrhage after superficial temporal artery-middle cerebral artery anastomosis in a patient with moyamoya disease: possible involvement of cerebral hyperperfusion and increased vascular permeability. Surg Neurol. 2009;71(2):223\u2013227."},{"issue":"4","key":"b8","series-title":"Neurosurgery.","first-page":"957","article-title":"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-[123I]iodoamphetamine single-photon emission computed tomography","volume":"68","author":"Fujimura M","year":"2011","unstructured":"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-[123I]iodoamphetamine single-photon emission computed tomography. Neurosurgery. 2011;68(4):957\u2013965."},{"issue":"2","key":"b9","series-title":"Acta Neuropathol.","first-page":"197","article-title":"Pathology and new players in the pathogenesis of brain edema","volume":"118","author":"Nag S","year":"2009","unstructured":"Nag S, Manias JL, Stewart DJ Pathology and new players in the pathogenesis of brain edema. Acta Neuropathol. 2009;118(2):197\u2013217."},{"issue":"2","key":"b10","series-title":"Neurosurgery.","first-page":"163","article-title":"Minocycline prevents focal neurological deterioration due to cerebral hyperperfusion after extracranial-intracranial bypass for moyamoya disease","volume":"74","author":"Fujimura M","year":"2014","unstructured":"Fujimura M, Niizuma K, Inoue T,  Minocycline prevents focal neurological deterioration due to cerebral hyperperfusion after extracranial-intracranial bypass for moyamoya disease. Neurosurgery. 2014;74(2):163\u2013170."},{"key":"b11","series-title":"World Neurosurg.","first-page":"e593","article-title":"Postoperative intracerebral hemorrhage after combined revascularization surgery in moyamoya disease: profiles and clinical associations","volume":"120","author":"Tokairin K","year":"2018","unstructured":"Tokairin K, Kazumata K, Uchino H,  Postoperative intracerebral hemorrhage after combined revascularization surgery in moyamoya disease: profiles and clinical associations. World Neurosurg. 2018;120:e593\u2013e600."},{"issue":"7","key":"b12","series-title":"Stroke.","first-page":"1930","article-title":"Edaravone reduces hyperperfusion-related neurological deficits in adult moyamoya disease: historical control study","volume":"47","author":"Uchino H","year":"2016","unstructured":"Uchino H, Nakayama N, Kazumata K, Kuroda S, Houkin K Edaravone reduces hyperperfusion-related neurological deficits in adult moyamoya disease: historical control study. Stroke. 2016;47(7):1930\u20131932."},{"issue":"7","key":"b13","series-title":"J Stroke Cerebrovasc Dis.","first-page":"e179","article-title":"Local vasogenic edema without cerebral hyperperfusion after direct revascularization surgery for moyamoya disease","volume":"24","author":"Sakata H","year":"2015","unstructured":"Sakata H, Fujimura M, Mugikura S, Sato K, Tominaga T Local vasogenic edema without cerebral hyperperfusion after direct revascularization surgery for moyamoya disease. J Stroke Cerebrovasc Dis. 2015;24(7):e179\u2013e184."},{"issue":"1","key":"b14","series-title":"J Neurosurg.","first-page":"1","article-title":"Clinical implications of the cortical hyperintensity belt sign in fluid-attenuated inversion recovery images after bypass surgery for moyamoya disease","volume":"126","author":"Hamano E","year":"2017","unstructured":"Hamano E, Kataoka H, Morita N,  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\u20137."},{"issue":"8","key":"b15","series-title":"J Stroke Cerebrovasc Dis.","first-page":"e172","article-title":"Paradoxical association of symptomatic local vasogenic edema with global cerebral hypoperfusion after direct revascularization surgery for adult moyamoya disease","volume":"27","author":"Tashiro R","year":"2018","unstructured":"Tashiro R, Fujimura M, Mugikura S,  Paradoxical association of symptomatic local vasogenic edema with global cerebral hypoperfusion after direct revascularization surgery for adult moyamoya disease. J Stroke Cerebrovasc Dis. 2018;27(8):e172\u2013e176."},{"issue":"4","key":"b16","series-title":"J Stroke Cerebrovasc Dis.","first-page":"104625","article-title":"Persistent local vasogenic edema with dynamic change in the regional cerebral blood flow after STA-MCA bypass for adult moyamoya disease","volume":"29","author":"Kawamura K","year":"2020","unstructured":"Kawamura K, Fujimura M, Tashiro R, Kanoke A, Saito A, Tominaga T Persistent local vasogenic edema with dynamic change in the regional cerebral blood flow after STA-MCA bypass for adult moyamoya disease. J Stroke Cerebrovasc Dis. 2020;29(4):104625."},{"issue":"1","key":"b17","series-title":"Neurosurg Rev.","first-page":"119","article-title":"Association of RNF213 polymorphism and cortical hyperintensity sign on fluid-attenuated inversion recovery images after revascularization surgery for moyamoya disease: possible involvement of intrinsic vascular vulnerability","volume":"46","author":"Uchino H","year":"2023","unstructured":"Uchino H, Ito M, Tokairin K,  Association of RNF213 polymorphism and cortical hyperintensity sign on fluid-attenuated inversion recovery images after revascularization surgery for moyamoya disease: possible involvement of intrinsic vascular vulnerability. Neurosurg Rev. 2023;46(1):119."},{"issue":"2","key":"b18","series-title":"Acta Neurochir (Wien).","first-page":"371","article-title":"In vivo demonstration of blood-brain barrier impairment in moyamoya disease","volume":"161","author":"Narducci A","year":"2019","unstructured":"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\u2013378."},{"issue":"7","key":"b19","series-title":"Invest Ophthalmol Vis Sci.","first-page":"1286","article-title":"Binding properties of indocyanine green in human blood","volume":"39","author":"Yoneya S","year":"1998","unstructured":"Yoneya S, Saito T, Komatsu Y, Koyama I, Takahashi K, Duvoll-Young J Binding properties of indocyanine green in human blood. Invest Ophthalmol Vis Sci. 1998;39(7):1286\u20131290."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/7\/13\/article-CASE2465.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/7\/13\/article-CASE2465.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/7\/13\/article-CASE2465.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T14:25:10Z","timestamp":1770301510000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/7\/13\/article-CASE2465.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,25]]},"references-count":38,"journal-issue":{"issue":"13"},"URL":"https:\/\/doi.org\/10.3171\/case2465","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,25]]}}}