{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:32:58Z","timestamp":1769725978411,"version":"3.49.0"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"9","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"\n BACKGROUND<\/jats:title>\n Moyamoya disease (MMD) is a progressive, steno-occlusive cerebrovascular disorder. Posterior cerebral artery (PCA) stenosis can develop after successful anterior circulation revascularization. Although symptomatic cerebral hyperperfusion (CHP) is a recognized complication of anterior revascularization, it is rarely reported following occipital artery (OA)\u2013PCA bypass.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors report the case of a 50-year-old woman with MMD who developed symptomatic hemodynamic compromise due to progressive right PCA stenosis 10 years after bilateral superficial temporal artery\u2013middle cerebral artery bypass and indirect revascularization. She underwent OA-PCA bypass with encephalo-myo-synangiosis. On postoperative day 1, single-photon emission CT revealed focal CHP in the right parietal lobe, with cerebral blood flow (CBF) increasing to 160% of preoperative levels. The patient developed a pulsatile headache and left-sided tongue numbness. By postoperative day 7, CBF had decreased to 110%, and perfusion had improved throughout the right parietal-occipital region. With strict blood pressure control and minocycline administration, both symptoms and CHP resolved. At the 1-year follow-up, the patient remained symptom free without stroke recurrence.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Symptomatic CHP can occur after OA-PCA bypass in MMD. Perioperative CHP management, including blood pressure control and anti-inflammatory therapy, is essential for optimal outcomes of posterior circulation bypass.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25486<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25486","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T23:49:08Z","timestamp":1756770548000},"source":"Crossref","is-referenced-by-count":0,"title":["Symptomatic cerebral hyperperfusion after occipital artery\u2013posterior cerebral artery bypass in a patient with moyamoya disease: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Jin","family":"Kimata","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kikutaro","family":"Tokairin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6567-8136","authenticated-orcid":true,"given":"Haruto","family":"Uchino","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0991-0516","authenticated-orcid":true,"given":"Miki","family":"Fujimura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","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","year":"1969","unstructured":"Suzuki JTakaku A.Cerebrovascular \u201cmoyamoya\u201d disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol. 1969;20(3):288-299."},{"issue":"5","key":"bib2","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","year":"2014","unstructured":"Miyamoto SYoshimoto THashimoto NEffects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial. Stroke. 2014;45(5):1415-1421."},{"issue":"5","key":"bib3","series-title":"J Neurosurg","first-page":"927","article-title":"Clinical outcome after 450 revascularization procedures for moyamoya disease.","volume":"111","author":"Guzman","year":"2009","unstructured":"Guzman RLee MAchrol AClinical outcome after 450 revascularization procedures for moyamoya disease.J Neurosurg. 2009;111(5):927-935."},{"issue":"4","key":"bib4","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","year":"2022","unstructured":"Fujimura MTominaga TKuroda S2021 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):165-170."},{"issue":"10","key":"bib5","series-title":"Stroke","first-page":"3025","article-title":"Long-term outcomes after combined revascularization surgery in adult moyamoya disease","volume":"45","author":"Cho","year":"2014","unstructured":"Cho WSKim JEKim CHLong-term outcomes after combined revascularization surgery in adult moyamoya disease. Stroke. 2014;45(10):3025-3031."},{"issue":"3","key":"bib6","series-title":"J Neurosurg","first-page":"909","article-title":"Late (5-20 years) outcomes after STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis in patients with moyamoya disease","volume":"134","author":"Kuroda","year":"2021","unstructured":"Kuroda SNakayama NYamamoto SLate (5-20 years) outcomes after STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis in patients with moyamoya disease. J Neurosurg. 2021;134(3):909-916."},{"issue":"5","key":"bib7","series-title":"Neurol Med Chir (Tokyo)","first-page":"327","article-title":"Lessons learned from moyamoya disease: outcome of direct\/indirect revascularization surgery for 150 affected hemispheres","volume":"52","author":"Fujimura","year":"2012","unstructured":"Fujimura MTominaga T.Lessons learned from moyamoya disease: outcome of direct\/indirect revascularization surgery for 150 affected hemispheres. Neurol Med Chir (Tokyo). 2012;52(5):327-332."},{"issue":"2","key":"bib8","series-title":"J Neurosurg","first-page":"432","article-title":"The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review","volume":"121","author":"Kazumata","year":"2014","unstructured":"Kazumata KIto MTokairin KThe frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review. J Neurosurg. 2014;121(2):432-440."},{"issue":"6","key":"bib9","series-title":"J Neurosurg","first-page":"1889","article-title":"Strategy and effect of repeat bypass surgery for anterior\/posterior circulation in refractory moyamoya disease","volume":"132","author":"Uchino","year":"2020","unstructured":"Uchino HKashiwazaki DAkioka NStrategy and effect of repeat bypass surgery for anterior\/posterior circulation in refractory moyamoya disease. J Neurosurg. 2020;132(6):1889-1899."},{"issue":"5","key":"bib10","series-title":"Neurosurgery","first-page":"852","article-title":"Strategies for and outcome of repeat revascularization surgery for moyamoya disease: an American institutional series","volume":"81","author":"Teo","year":"2017","unstructured":"Teo MJohnson JSteinberg GK.Strategies for and outcome of repeat revascularization surgery for moyamoya disease: an American institutional series. 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J Neurosurg. 2011;115(2):328-336."},{"issue":"1","key":"bib12","series-title":"Neurosurgery","first-page":"E195","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","unstructured":"Hayashi TShirane RTominaga T.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. Neurosurgery. 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Surg Neurol. 2009;71(2):223-227."},{"key":"bib17","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","year":"2018","unstructured":"Tokairin KKazumata KUchino HPostoperative intracerebral hemorrhage after combined revascularization surgery in moyamoya disease: profiles and clinical associations. World Neurosurg. 2018;120:e593-e600."},{"issue":"5","key":"bib18","series-title":"Cerebrovasc Dis","first-page":"436","article-title":"Efficacy of prophylactic blood pressure lowering according to a standardized postoperative management protocol to prevent symptomatic cerebral hyperperfusion after direct revascularization surgery for moyamoya disease","volume":"33","author":"Fujimura","year":"2012","unstructured":"Fujimura MInoue TShimizu HSaito AMugikura STominaga T.Efficacy of prophylactic blood pressure lowering according to a standardized postoperative management protocol to prevent symptomatic cerebral hyperperfusion after direct revascularization surgery for moyamoya disease. 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Stroke. 2016;47(7):1930-1932."},{"issue":"3","key":"bib21","series-title":"Neurol Med Chir (Tokyo)","first-page":"120","article-title":"Systemic immune-inflammation index is associated with symptomatic cerebral hyperperfusion after revascularization surgery in moyamoya disease","volume":"65","author":"Yamamoto","year":"2025","unstructured":"Yamamoto TUchino HIto MSugiyama TFujimura M.Systemic immune-inflammation index is associated with symptomatic cerebral hyperperfusion after revascularization surgery in moyamoya disease. Neurol Med Chir (Tokyo). 2025;65(3):120-125."},{"issue":"3-6","key":"bib22","series-title":"Cerebrovasc Dis","first-page":"217","article-title":"Significance of quantitative cerebral blood flow measurement in the acute stage after revascularization surgery for adult moyamoya disease: implication for the pathological threshold of local cerebral hyperperfusion","volume":"48","author":"Kameyama","year":"2019","unstructured":"Kameyama MFujimura MTashiro RSignificance of quantitative cerebral blood flow measurement in the acute stage after revascularization surgery for adult moyamoya disease: implication for the pathological threshold of local cerebral hyperperfusion. Cerebrovasc Dis. 2019;48(3-6):217-225."},{"issue":"4","key":"bib23","series-title":"Acta Neurochir (Wien)","first-page":"1037","article-title":"Delayed development of cerebral atrophy after cerebral hyperperfusion following arterial bypass for adult patients with ischemic moyamoya disease: supplementary analysis of a 5-year prospective cohort","volume":"164","author":"Katakura","year":"2022","unstructured":"Katakura YKubo YDobashi KDelayed development of cerebral atrophy after cerebral hyperperfusion following arterial bypass for adult patients with ischemic moyamoya disease: supplementary analysis of a 5-year prospective cohort. Acta Neurochir (Wien). 2022;164(4):1037-1045."},{"issue":"7","key":"bib24","series-title":"Neurol Med Chir (Tokyo)","first-page":"272","article-title":"Effective smartphone application use for postoperative management of moyamoya disease","volume":"64","author":"Uchino","year":"2024","unstructured":"Uchino HOsanai TIto MKurisu KSugiyama TFujimura M.Effective smartphone application use for postoperative management of moyamoya disease. Neurol Med Chir (Tokyo). 2024;64(7):272-277."},{"key":"bib25","series-title":"World Neurosurg","first-page":"101","article-title":"Focal cerebellar hyperperfusion after bypass surgery for vertebrobasilar ischemia: effect of cerebrovascular reactivity as a potential predictor of hyperperfusion","volume":"140","author":"Endo","year":"2020","unstructured":"Endo HFujimura MNishizawa TSaito ATominaga T.Focal cerebellar hyperperfusion after bypass surgery for vertebrobasilar ischemia: effect of cerebrovascular reactivity as a potential predictor of hyperperfusion. World Neurosurg. 2020;140:101-106."},{"issue":"3","key":"bib26","series-title":"J Stroke Cerebrovasc Dis","first-page":"583","article-title":"Posterior circulation hyperperfusion syndrome after superficial temporal artery-superior cerebellar artery bypass for vertebral artery dissection","volume":"23","author":"Fukuda","year":"2014","unstructured":"Fukuda KAbe HUeba TOkawa MHigashi TInoue T.Posterior circulation hyperperfusion syndrome after superficial temporal artery-superior cerebellar artery bypass for vertebral artery dissection. J Stroke Cerebrovasc Dis. 2014;23(3):583-586."},{"key":"bib27","series-title":"Cerebrovasc Dis","article-title":"Diagnostic values of the \u201cto and fro\u201d conflict sign on intraoperative indocyanine green video angiography as a warning sign of the focal cerebral hyperperfusion and watershed shift phenomenon after superficial temporal artery-middle cerebral artery bypass for adult patients with moyamoya disease","author":"Tashiro","year":"2025","unstructured":"Tashiro RFujimura MNishizawa TTominaga KKanoke AEndo H.Diagnostic values of the \u201cto and fro\u201d conflict sign on intraoperative indocyanine green video angiography as a warning sign of the focal cerebral hyperperfusion and watershed shift phenomenon after superficial temporal artery-middle cerebral artery bypass for adult patients with moyamoya disease. Cerebrovasc Dis. Published online June 12, 2025. doi:10.1159\/000546826"},{"issue":"3","key":"bib1","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","year":"1969","unstructured":"Suzuki JTakaku A.Cerebrovascular \u201cmoyamoya\u201d disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol. 1969;20(3):288-299."},{"issue":"5","key":"bib2","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","year":"2014","unstructured":"Miyamoto SYoshimoto THashimoto NEffects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial. Stroke. 2014;45(5):1415-1421."},{"issue":"5","key":"bib3","series-title":"J Neurosurg","first-page":"927","article-title":"Clinical outcome after 450 revascularization procedures for moyamoya disease.","volume":"111","author":"Guzman","year":"2009","unstructured":"Guzman RLee MAchrol AClinical outcome after 450 revascularization procedures for moyamoya disease.J Neurosurg. 2009;111(5):927-935."},{"issue":"4","key":"bib4","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","year":"2022","unstructured":"Fujimura MTominaga TKuroda S2021 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):165-170."},{"issue":"10","key":"bib5","series-title":"Stroke","first-page":"3025","article-title":"Long-term outcomes after combined revascularization surgery in adult moyamoya disease","volume":"45","author":"Cho","year":"2014","unstructured":"Cho WSKim JEKim CHLong-term outcomes after combined revascularization surgery in adult moyamoya disease. Stroke. 2014;45(10):3025-3031."},{"issue":"3","key":"bib6","series-title":"J Neurosurg","first-page":"909","article-title":"Late (5-20 years) outcomes after STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis in patients with moyamoya disease","volume":"134","author":"Kuroda","year":"2021","unstructured":"Kuroda SNakayama NYamamoto SLate (5-20 years) outcomes after STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis in patients with moyamoya disease. J Neurosurg. 2021;134(3):909-916."},{"issue":"5","key":"bib7","series-title":"Neurol Med Chir (Tokyo)","first-page":"327","article-title":"Lessons learned from moyamoya disease: outcome of direct\/indirect revascularization surgery for 150 affected hemispheres","volume":"52","author":"Fujimura","year":"2012","unstructured":"Fujimura MTominaga T.Lessons learned from moyamoya disease: outcome of direct\/indirect revascularization surgery for 150 affected hemispheres. Neurol Med Chir (Tokyo). 2012;52(5):327-332."},{"issue":"2","key":"bib8","series-title":"J Neurosurg","first-page":"432","article-title":"The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review","volume":"121","author":"Kazumata","year":"2014","unstructured":"Kazumata KIto MTokairin KThe frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review. J Neurosurg. 2014;121(2):432-440."},{"issue":"6","key":"bib9","series-title":"J Neurosurg","first-page":"1889","article-title":"Strategy and effect of repeat bypass surgery for anterior\/posterior circulation in refractory moyamoya disease","volume":"132","author":"Uchino","year":"2020","unstructured":"Uchino HKashiwazaki DAkioka NStrategy and effect of repeat bypass surgery for anterior\/posterior circulation in refractory moyamoya disease. J Neurosurg. 2020;132(6):1889-1899."},{"issue":"5","key":"bib10","series-title":"Neurosurgery","first-page":"852","article-title":"Strategies for and outcome of repeat revascularization surgery for moyamoya disease: an American institutional series","volume":"81","author":"Teo","year":"2017","unstructured":"Teo MJohnson JSteinberg GK.Strategies for and outcome of repeat revascularization surgery for moyamoya disease: an American institutional series. Neurosurgery. 2017;81(5):852-859."},{"issue":"2","key":"bib11","series-title":"J Neurosurg","first-page":"328","article-title":"Outcome of repeat revascularization surgery for moyamoya disease after an unsuccessful indirect revascularization.","volume":"115","author":"Pandey","year":"2011","unstructured":"Pandey PSteinberg GK.Outcome of repeat revascularization surgery for moyamoya disease after an unsuccessful indirect revascularization.Clinical article. J Neurosurg. 2011;115(2):328-336."},{"issue":"1","key":"bib12","series-title":"Neurosurgery","first-page":"E195","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","unstructured":"Hayashi TShirane RTominaga T.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. Neurosurgery. 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Stroke. 2012;43(10):2610-2616."},{"issue":"3","key":"bib15","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","year":"2007","unstructured":"Fujimura MKaneta TMugikura SShimizu HTominaga T.Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease. 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Stroke. 2016;47(7):1930-1932."},{"issue":"3","key":"bib21","series-title":"Neurol Med Chir (Tokyo)","first-page":"120","article-title":"Systemic immune-inflammation index is associated with symptomatic cerebral hyperperfusion after revascularization surgery in moyamoya disease","volume":"65","author":"Yamamoto","year":"2025","unstructured":"Yamamoto TUchino HIto MSugiyama TFujimura M.Systemic immune-inflammation index is associated with symptomatic cerebral hyperperfusion after revascularization surgery in moyamoya disease. Neurol Med Chir (Tokyo). 2025;65(3):120-125."},{"issue":"3-6","key":"bib22","series-title":"Cerebrovasc Dis","first-page":"217","article-title":"Significance of quantitative cerebral blood flow measurement in the acute stage after revascularization surgery for adult moyamoya disease: implication for the pathological threshold of local cerebral hyperperfusion","volume":"48","author":"Kameyama","year":"2019","unstructured":"Kameyama MFujimura MTashiro RSignificance of quantitative cerebral blood flow measurement in the acute stage after revascularization surgery for adult moyamoya disease: implication for the pathological threshold of local cerebral hyperperfusion. Cerebrovasc Dis. 2019;48(3-6):217-225."},{"issue":"4","key":"bib23","series-title":"Acta Neurochir (Wien)","first-page":"1037","article-title":"Delayed development of cerebral atrophy after cerebral hyperperfusion following arterial bypass for adult patients with ischemic moyamoya disease: supplementary analysis of a 5-year prospective cohort","volume":"164","author":"Katakura","year":"2022","unstructured":"Katakura YKubo YDobashi KDelayed development of cerebral atrophy after cerebral hyperperfusion following arterial bypass for adult patients with ischemic moyamoya disease: supplementary analysis of a 5-year prospective cohort. 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