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February 28, 2026

Intraoperative Diabetes Insipidus as a Predictor of Postoperative Complications Following Revascularization in Moyamoya Disease: A Retrospective Cohort Study

Key Points

This study aims to evaluate the role of intraoperative diabetes insipidus as a predictor of postoperative complications in moyamoya disease revascularization.
Retrospective analysis of 273 revascularization procedures
Conducted at North Campus of Huashan Hospital from November 2019 to December 2022
Used univariate and multivariate logistic regression to identify risk factors
Postoperative hyperperfusion syndrome occurred in 42.4% of cases
Postoperative stroke occurred in 8.0% of cases
Intraoperative diabetes insipidus was present in 45.2% of cases
Higher incidence of complications linked with intraoperative diabetes insipidus (p = 0.02)
Multivariate analysis identified intraoperative diabetes insipidus and high BMI as independent risk factors

Abstract

Background: Surgical revascularization represents an effective treatment for moyamoya disease (MMD); however, it is associated with postoperative complications such as stroke and hyperperfusion syndrome. Intraoperative polyuria and electrolyte disturbances resembling diabetes insipidus (DI) are frequently observed, yet their clinical significance remains unclear. This study aimed to identify potential risk factors for postoperative complications and to evaluate the predictive value of intraoperative DI in individuals undergoing revascularization for MMD. Methods: A retrospective analysis was conducted on 273 consecutive revascularization procedures performed at the North Campus of Huashan Hospital between November 2019 and December 2022. Univariate and multivariate logistic regression analyses were used to identify independent risk factors of postoperative complications occurring within 30 days. Risk factors for intraoperative DI were assessed, and a nomogram-based predictive model was constructed. Results: Postoperative hyperperfusion syndrome occurred in 106 cases (42.4%), and postoperative stroke in 20 cases (8.0%). Intraoperative DI was observed in 113 cases (45.2%). The incidence of postoperative complications was significantly higher among individuals who experienced intraoperative DI compared to those who did not (p = 0.02). Multivariate analysis identified intraoperative DI (p = 0.011), elevated body mass index (BMI) (p = 0.032), and ischemictype MMD (p = 0.015) as independent risk factors for postoperative complications. In addition, high BMI was associated with an increased risk of intraoperative DI. The predictive model demonstrated good performance with an area under the curve of 0.798. Discussion: This study highlights intraoperative DI, elevated BMI, and ischemic-type MMD as independent predictors of postoperative complications. The link between high BMI and DI suggests a potential interaction. Incorporating these factors into perioperative assessment may improve risk stratification and guide preventative strategies to enhance surgical outcomes in MMD patients. Conclusion: The association between high BMI and intraoperative DI indicates a potential predictive relationship, which may support perioperative risk stratification in individuals with MMD.

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