ИСТИНА

Background. The complex restructuring of cerebral circulation, characteristic of Moyamoya disease, causes an increased risk of developing perioperative ischemic complications. Their prevention is one of the most difficult problems of surgical treatment of this pathology. The aim of the study was to identify unfavorable prognostic factors for the development of cerebral ischemic complications of surgical interventions, to identify a group of patients at increased risk and to develop recommendations for the perioperative management of this category of patients. Methods. The clinical and instrumental data and the results of surgical treatment of 80 patients with various forms of Moyamoya angiopathy, who underwent 134 different surgical revascularization interventions, were analyzed. 40 patients underwent staged revascularization of both hemispheres (80 operations). The majority of patients (n=55) underwent combined brain revascularization (79 operations). Results. Persistent complications of surgical treatment in the form of ischemic stroke developed in 7 cases (5.3%), temporary episodes of increasing neurological deficit - in 36 cases (27%). Risk factors for perioperative complications were critical stenosis/occlusion of the PCA (OR 9.704), severe perfusion deficit (OR 5.393) and TIA or a history of ischemic stroke within 3 months before surgery (OR 6.433). In the presence of at least two signs, the sensitivity and specificity in predicting postoperative complications were 80.7% and 88.6%, respectively. Conclusions. Patients with Moyamoya disease are at high risk of perioperative complications due to complex restructuring of collateral cerebral circulation and high sensitivity of the brain to changes in local and systemic hemodynamics. Patients with risk factors require particularly careful perioperative management in order to exclude pathogenic factors that provoke ischemia. Surgical treatment should be performed preventively in the early stages of the disease to reduce the risk of developing both ischemic and hemorrhagic lesions due to the natural course of the disease, and severe perioperative complications.