Effect of cerebral oxygen saturation monitoring in patients undergoing superficial temporal anterior-middle cerebral artery anastomosis for ischemic Moyamoya disease: a prospective cohort study

Abstract

Objective: Regional cerebral oxygen saturation (rSO₂) is linked with blood pressure. This study evaluated the influence of perioperative rSO₂ monitoring on the prognosis of ischemic Moyamoya disease (MMD) patients undergoing anastomosis surgery.

Methods: In this prospective cohort, patients with unilateral ischemic MMD of Suzuki stage ≥3 were included. The decision of rSO₂ was made by the clinician and the patient. The rSO₂ group maintained intraoperative rSO₂ levels through the modulation of blood pressure, inhaled oxygen concentration, carbon dioxide in arterial blood, and red blood cell transfusion. The non-rSO₂ group used conventional anesthesia practices. Perioperative mean arterial pressure (MAP), rSO₂ values, neurological complications, and postoperative results were assessed.

Results: A total of 75 eligible patients were categorized into a rSO₂ monitoring group (n = 30) and a non-rSO₂ monitoring group (n = 45). For the rSO₂ group, the preoperative rSO₂ was significantly lower on the affected side (P < 0.05). After anastomosis, this value notably increased (P = 0.01). A moderate relationship was observed between perioperative rSO₂ and MAP before, during, and after surgery, with correlation coefficients (r) of 0.536, 0.502, and 0.592 (P < 0.05). Post-surgery MAP levels differed between the groups, with the rSO₂ group showing decreased levels compared to pre-surgery and the non-rOS₂ group displaying elevated levels. Notably, the rSO₂ group reported shorter hospitalizations and decreased neurological complications. Patients with a hypertension history found postoperative MAP influencing hospital stay duration.

Conclusion: Perioperative rSO₂ surveillance enhanced cerebral perfusion and minimized postoperative complications in ischemic MMD patients. Thus, rSO₂ monitoring is advocated for MMD patients undergoing vascular anastomosis.

Keywords: anesthesia management; ischemic MMD; mean arterial pressure; regional cerebral oxygen saturation (rSO2); superficial temporal artery-middle cerebral artery anastomosis.