Cortical Vein Redness as a Surrogate Marker for Predicting Transient Neurological Events after Revascularization in Adult Moyamoya Disease

Background and Objectives 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 cerebral blood flow changes and may serve as a surrogate for such 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. Methods 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 Orbeye images. The change in R intensity (ΔR) was calculated as the ratio of post- to pre-anastomosis values. Associations between ΔR and TNE occurrence were evaluated using logistic regression analysis. Results 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). ΔR was identified as an independent predictor of TNEs via multivariate logistic regression; a one standard deviation increase in ΔR was associated with an approximately 14-fold higher odds of developing TNEs (p = .001). Conclusion Increased ΔR was independently associated with TNE occurrence post-revascularization for moyamoya disease. Quantitative assessment of cortical venous redness may serve as a practical and novel intraoperative marker for predicting TNEs.