Abstract WMP70: A Novel Hyperspectral Imaging System For Intraoperative Prediction Of Cerebral Hyperperfusion Syndrome After Superficial Temporal Artery-middle Cerebral Artery Anastomosis In Patients With Moyamoya Disease

Background: Postoperative cerebral hyperperfusion syndrome (CHS) may occur after superficial temporal artery (STA)-middle cerebral artery (MCA) bypass for moyamoya disease (MMD). Predicting postoperative CHS is challenging; however, we previously presented the feasibility of using a hyperspectral camera (HSC) for monitoring intraoperative changes in brain surface hemodynamics during STA-MCA bypass. Objective: To investigate the utility of HSC to predict postoperative CHS during STA-MCA bypass for patients with MMD. Methods: Hyperspectral images of the cerebral cortex of twenty nine patients with MMD who underwent STA-MCA bypass were acquired by an HSC before and after anastomosis. We then analyzed the changes in oxygen saturation after anastomosis and assessed its correlation with CHS. Results: Five patients experienced transient neurological deterioration several days after surgery. 123 I-N-isopropyl-iodoamphetamine single-photon emission computed tomography scan results revealed an intense, focal increase in cerebral blood flow (CBF) at the site of anastomosis without any cerebral infarction. Patients with CHS showed significantly increased oxygen saturation (SO 2 ) in the cerebral cortex after anastomosis relative to those without CHS (33 ± 28% vs. 8 ± 14%, P<.0001). Receiver operating characteristic analysis results show that postoperative CHS likely occurs when the increase rate of cortical SO 2 value is more than 15% (sensitivity, 85.0%; specificity, 81.3%; area under curve, 0.871). Conclusions: This study indicates that hyperspectral imaging of the cerebral cortex may be used to predict postoperative CHS in patients with MMD undergoing STA-MCA bypass.