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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Predictors of Early Postoperative Seizures Following STA–MCA Bypass in Adult Moyamoya Angiopathy

  • Riccardo Ciocca1
  • Nazeer Aboud2
  • Erica Boccardi1
  • Daniel Sarmiento3
  • Ricardo Borda3
  • Alessandro Tozzi4
  • Elisa Ciceri4
  • The The MoMo-Besta-Team1,4,5,6
  • Marco Paolo Schiariti1
  • Francesco Restelli1
  • Paolo Ferroli1
  • Sergio A. Calero Calero Martinez1,2,4,7
7 affiliations
  1. 1Department of Neurosurgery, Section of Vascular and Skull Base, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
  2. 2Department of Neurosurgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
  3. 3Department of Statistics, El Bosque University, Carrera 9 No. 131 A–02, Bogotá 110121, Colombia
  4. 4SC Radiologia Diagnostica per Immagini e Neuroradiologia Interventistica, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
  5. 5Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
  6. 6Department for Anesthesiology and Intensive Care Medicine, IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
  7. 7Instituto de Neurociencias, El Bosque University, Carrera 9 No. 131 A–02, Bogotá 110121, Colombia
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Abstract

Background: Postoperative epileptic seizures are a recognized complication after superficial temporal artery–middle cerebral artery (STA–MCA) bypass for Moyamoya angiopathy (MMA), but their determinants remain incompletely understood. We aimed to identify clinical, radiological, and perioperative factors associated with early postoperative seizures following adult STA–MCA bypass. Methods: We retrospectively analyzed 75 hemispheric revascularization procedures performed in adult MMA patients between 2005 and 2023, with each operated hemisphere treated as an independent analytical unit. The primary outcome was the occurrence of at least one in-hospital postoperative seizure; the primary exposure was cerebral hyperperfusion syndrome. Univariate and multivariable Firth penalized-likelihood logistic regression was used to account for the small sample size and rare outcome. Results: Postoperative seizures occurred in 14 of 75 procedures (18.7%). Hyperperfusion was identified in 6 procedures (8.0%) and showed the strongest univariate association with seizures (OR 10.20), followed by diabetes mellitus (OR 6.05). Right-hemispheric procedures showed a protective effect in the univariate analysis (OR 0.24). In separate multivariate adjusted models, hyperperfusion (OR 10.28) and diabetes mellitus (OR 5.70) remained associated with postoperative seizures (OR 10.28 and OR 5.70, respectively). Pre-existing epilepsy, antiepileptic treatment, and preoperative EEG abnormalities were not associated with seizure risk. Conclusions: Early postoperative seizures after direct STA–MCA bypass in adult MMA were most consistently associated with postoperative cerebral hyperperfusion in our cohort, while pre-existing epilepsy and preoperative EEG abnormalities showed no statistically significant associations. Early recognition of hyperperfusion may support risk-stratified postoperative surveillance and individualized management.

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Cite

BibTeXRIS
BibTeX
@article{ciocca2026predictors,
  title = {{Predictors of Early Postoperative Seizures Following STA–MCA Bypass in Adult Moyamoya Angiopathy}},
  author = {Riccardo Ciocca and Nazeer Aboud and Erica Boccardi and Daniel Sarmiento and Ricardo Borda and Alessandro Tozzi and Elisa Ciceri and The The MoMo-Besta-Team and Marco Paolo Schiariti and Francesco Restelli and Paolo Ferroli and Sergio A. Calero Calero Martinez},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15218448},
  url = {https://www.mdpi.com/2077-0383/15/21/8448},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Predictors of Early Postoperative Seizures Following STA–MCA Bypass in Adult Moyamoya Angiopathy
AU  - Riccardo Ciocca
AU  - Nazeer Aboud
AU  - Erica Boccardi
AU  - Daniel Sarmiento
AU  - Ricardo Borda
AU  - Alessandro Tozzi
AU  - Elisa Ciceri
AU  - The The MoMo-Besta-Team
AU  - Marco Paolo Schiariti
AU  - Francesco Restelli
AU  - Paolo Ferroli
AU  - Sergio A. Calero Calero Martinez
PY  - 2026
DA  - 2026/10/30
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218448
UR  - https://www.mdpi.com/2077-0383/15/21/8448
AB  - Background: Postoperative epileptic seizures are a recognized complication after superficial temporal artery–middle cerebral artery (STA–MCA) bypass for Moyamoya angiopathy (MMA), but their determinants remain incompletely understood. We aimed to identify clinical, radiological, and perioperative factors associated with early postoperative seizures following adult STA–MCA bypass. Methods: We retrospectively analyzed 75 hemispheric revascularization procedures performed in adult MMA patients between 2005 and 2023, with each operated hemisphere treated as an independent analytical unit. The primary outcome was the occurrence of at least one in-hospital postoperative seizure; the primary exposure was cerebral hyperperfusion syndrome. Univariate and multivariable Firth penalized-likelihood logistic regression was used to account for the small sample size and rare outcome. Results: Postoperative seizures occurred in 14 of 75 procedures (18.7%). Hyperperfusion was identified in 6 procedures (8.0%) and showed the strongest univariate association with seizures (OR 10.20), followed by diabetes mellitus (OR 6.05). Right-hemispheric procedures showed a protective effect in the univariate analysis (OR 0.24). In separate multivariate adjusted models, hyperperfusion (OR 10.28) and diabetes mellitus (OR 5.70) remained associated with postoperative seizures (OR 10.28 and OR 5.70, respectively). Pre-existing epilepsy, antiepileptic treatment, and preoperative EEG abnormalities were not associated with seizure risk. Conclusions: Early postoperative seizures after direct STA–MCA bypass in adult MMA were most consistently associated with postoperative cerebral hyperperfusion in our cohort, while pre-existing epilepsy and preoperative EEG abnormalities showed no statistically significant associations. Early recognition of hyperperfusion may support risk-stratified postoperative surveillance and individualized management.
SN  - 2077-0383
ER  -