ИСТИНА

Objective. Identification of unfavorable prognostic factors for the development of cerebral ischemic complications of surgical treatment in patients with moyamoya disease, identification of a group of patients with increased surgical risk. Methods. From 2008 to 2020 in the Burdenko Center of Neurosurgery observed 80 patients with moyamoya disease, who underwent 134 surgical interventions for brain revascularization. The age of the patients varied from 2 to 41 years (average 14.6 years). 55 patients underwent combined brain revascularization (79 operations), 14 patients - 19 direct revascularizations, 17 patients - 36 indirect surgeries. Ischemic complications were assessed in the early postoperative period and were represented by transient and persistent cerebrovascular accidents (CVA). Persistent complications (ischemic strokes) developed in 7 cases (5.3%). In 36 cases (27%) there were short-term episodes of transient neurologic deficit. Results. The statistical analysis revealed factors associated with the development of transient and persistent ischemic complications: neuroradiological "ivy-sign" (χ2=4.078, p=0.043), stenosis of the ICA proximal to the posterior communicating or posterior cerebral artery ostium (χ2=20.085, p<0.0001), decompensation of cerebral blood flow (χ2=11.212, p<0.001), recent CVA (less than 3 months before surgery) or instability of neurological symptoms (χ2=6.146, p<0.013). Significant factors of the development of persistent ischemic stroke were: stenosis or occlusion of the ipsilateral posterior cerebral artery (increased the risk of stroke by 9.7 times); signs of decompensation of cerebral perfusion (increased risk by 5.4 times), unstable clinical symptoms or CVA within 3 months before surgery (increased risk by 6.4 times). The presence of at least two signs defines a group of patients with increased risk of complications with a sensitivity of 80.7% and a specificity of 88.6%. Conclusion. The identified risk factors will make it possible to predict the risk of perioperative ischemic complications in patients with moyamoya disease and optimize management tactics and improve the results of surgical treatment.