Neurosurg Rev. 2026 Feb 7;49(1):207. doi: 10.1007/s10143-026-04163-7.
ABSTRACT
Transient neurological events (TNEs) frequently occur after direct revascularization in adult moyamoya disease, often due to acute alterations in cerebral hemodynamics. Cortical venous redness has been linked to perioperative hemodynamic alterations; therefore, we investigated whether changes in cortical venous redness, quantified as red signal intensity (R intensity) around the anastomosis site, could predict TNE occurrence. In this retrospective study, we analyzed 52 hemispheres from 42 patients who underwent combined revascularization surgery for moyamoya disease. Cortical venous R intensity was measured pre- and post-anastomosis using exoscope images. The change in R intensity of the cortical vein, normalized to adjacent cortical surface (ΔNR), was calculated as the ratio of post- to pre-anastomosis values. Associations between ΔNR and TNE occurrence were evaluated using logistic regression analysis. TNEs occurred in 21 of 52 hemispheres (40.4%), with a median onset of 4 days (interquartile range [IQR], 2-6) following revascularization and duration of 6 days (IQR, 3-8). ΔNR was identified as an independent predictor of TNEs via Firth penalized logistic regression; a 0.1-unit increase in ΔNR was associated with a 7.58-fold higher odds of developing TNEs (p < 0.001). Increased ΔNR was independently associated with TNE occurrence post-revascularization for moyamoya disease. Quantitative assessment of cortical venous redness may serve as a potentially useful marker for predicting TNEs.
PMID:41653330 | DOI:10.1007/s10143-026-04163-7