Skip to main content
SpringerLink
Log in

Effect of Mouth Opening on Bypass Function After Combined Revascularization for Moyamoya Disease

  • Conference paper
  • First Online:
Trends in Neurovascular Surgery

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 112))

Abstract

Moyamoya disease represents a rare steno-occlusive disease of the internal carotid artery (ICA) with a reactive and pathological basal network of collateral vessels. It may lead to ischemic stroke or intracerebral hemorrhage. Treatment options are either direct or indirect revascularization procedures or a combination thereof. Specialized centers report sufficient revascularization in most patients and low complication rates.

Between 2005 and 2008, direct extra-intracranial bypass surgery in combination with encephalomyosynangiosis (EMS) was performed in 71 Moyamoya patients at the Mannheim University Medical Center.

Following one case of reversible neurological deficits associated with mouth opening, we prospectively evaluated the effect of mouth opening on bypass function in this patient and four further consecutive patients by digital subtraction angiography.

Three out of five patients showed alterations in bypass patency upon mouth opening. The obstruction was located at the junction of the bypass and the temporal muscle. Two temporary occlusions and one case of decreased flow were observed. One patient demonstrated reversible hemiparesis and aphasia.

‡Authors Freyschlag CF and Seiz M contributed equally to this study.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Andrews BT, Chater NL, Weinstein PR (1985) Extracranial-intracranial arterial bypass for middle cerebral artery stenosis and occlusion. Operative results in 65 cases. J Neurosurg 6:831–838. doi:10.3171/jns.1985.62.6.0831

    Google Scholar 

  2. Baaj AA, Agazzi S, Sayed ZA, Toledo M, Spetzler RF, van Loveren H (2009) Surgical management of Moyamoya disease: a review. Neurosurg Focus 4:E7. doi:10.3171/2009.01.FOCUS08293

    Article  Google Scholar 

  3. Burke GM, Burke AM, Sherma AK, Hurley MC, Batjer HH, Bendok BR (2009) Moyamoya disease: a summary. Neurosurg Focus 4:E11. doi:10.3171/2009.1.FOCUS08310

    Article  Google Scholar 

  4. Choi JU, Kim DS, Kim EY, Lee KC (1997) Natural history of Moyamoya disease: comparison of activity of daily living in surgery and nonsurgery groups. Clin Neurol Neurosurg 99(Suppl 2):S11–S18

    Article  PubMed  Google Scholar 

  5. Czabanka M, Vajkoczy P, Schmiedek P, Horn P (2009) Age-dependent revascularization patterns in the treatment of Moyamoya disease in a European patient population. Neurosurg Focus 4:E9. doi:10.3171/2009.1.FOCUS08298

    Article  Google Scholar 

  6. Donaghy RM (1972) Neurologic surgery. Surg Gynecol Obstet 2:269–270

    Google Scholar 

  7. Fujimura M, Kaneta T, Shimizu H, Tominaga T (2009) Cerebral ischemia owing to compression of the brain by swollen temporal muscle used for encephalo-myo-synangiosis in Moyamoya disease. Neurosurg Rev 2:245–249. doi:10.1007/s10143-009-0184-6; discussion 249

    Article  Google Scholar 

  8. Fung LW, Thompson D, Ganesan V (2005) Revascularisation surgery for paediatric Moyamoya: a review of the literature. Childs Nerv Syst 5:358–364. doi:10.1007/s00381-004-1118-9

    Article  Google Scholar 

  9. Golby AJ, Marks MP, Thompson RC, Steinberg GK (1999) Direct and combined revascularization in pediatric Moyamoya disease. Neurosurgery 1:50–58; discussion 58–60

    Article  Google Scholar 

  10. Gratzl O, Schmiedek P, Spetzler R, Steinhoff H, Marguth F (1976) Clinical experience with extra-intracranial arterial anastomosis in 65 cases. J Neurosurg 3:313–324. doi:10.3171/jns.1976.44.3.0313

    Google Scholar 

  11. Guzman R, Lee M, Achrol A, Bell-Stephens T, Kelly M, Do HM et al (2009) Clinical outcome after 450 revascularization procedures for Moyamoya disease. Clinical article. J Neurosurg 5:927–935. doi:10.3171/2009.4.JNS081649

    Google Scholar 

  12. Houkin K, Ishikawa T, Yoshimoto T, Abe H (1997) Direct and indirect revascularization for Moyamoya disease surgical techniques and peri-operative complications. Clin Neurol Neurosurg 99(Suppl 2):S142–S145

    PubMed  Google Scholar 

  13. Janda V, Sachse J (2000) Manuelle Muskelfunktionsdiagnostik. 4. Auflage, Urban & Fischer.

    Google Scholar 

  14. Kawaguchi T, Fujita S, Hosoda K, Shose Y, Hamano S, Iwakura M et al (1996) Multiple burr-hole operation for adult Moyamoya disease. J Neurosurg 3:468–476. doi:10.3171/jns.1996.84.3.0468

    Google Scholar 

  15. Komotar RJ, Starke RM, Otten ML, Merkow MB, Garrett MC, Marshall RS et al (2009) The role of indirect extracranial-intracranial bypass in the treatment of symptomatic intracranial atheroocclusive disease. J Neurosurg 5:896–904. doi:10.3171/2008.9.JNS17658

    Google Scholar 

  16. Matsushima T, Inoue T, Ikezaki K, Matsukado K, Natori Y, Inamura T et al (1998) Multiple combined indirect procedure for the surgical treatment of children with Moyamoya disease. A comparison with single indirect anastomosis and direct anastomosis. Neurosurg Focus 5:e4

    Article  PubMed  CAS  Google Scholar 

  17. Matsushima T, Inoue T, Suzuki SO, Fujii K, Fukui M, Hasuo K (1992) Surgical treatment of moyamoya disease in pediatric patients–comparison between the results of indirect and direct revascularization procedures. Neurosurgery 3:401–405

    Article  Google Scholar 

  18. Mesiwala AH, Sviri G, Fatemi N, Britz GW, Newell DW (2008) Long-term outcome of superficial temporal artery-middle cerebral artery bypass for patients with Moyamoya disease in the US. Neurosurg Focus 2:E15. doi:10.3171/FOC/2008/24/2/E15

    Article  Google Scholar 

  19. Reis CV, Safavi-Abbasi S, Zabramski JM, Gusmao SN, Spetzler RF, Preul MC (2006) The history of neurosurgical procedures for Moyamoya disease. Neurosurg Focus 6:E7

    Google Scholar 

  20. Scott RM, Smith ER (2009) Moyamoya disease and Moyamoya syndrome. N Engl J Med 12:1226–1237. doi:10.1056/NEJMra0804622

    Article  Google Scholar 

  21. Smith ER, Scott RM (2005) Surgical management of Moyamoya syndrome. Skull Base 1:15–26. doi:10.1055/s-2005-868160

    Article  Google Scholar 

  22. Starke RM, Komotar RJ, Connolly ES (2009) Optimal surgical treatment for moyamoya disease in adults: direct versus indirect bypass. Neurosurg Focus 4:E8. doi:10.3171/2009.01.FOCUS08309

    Article  Google Scholar 

  23. Suzuki J, Takaku A (1969) Cerebrovascular “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 3:288–299

    Article  Google Scholar 

  24. Takeuchi K, Shimizu K (1957) Hypoplasia of the bilateral internal carotid arteries. No To Shinkei 9:37–43

    Google Scholar 

  25. Wakai K, Tamakoshi A, Ikezaki K, Fukui M, Kawamura T, Aoki R et al (1997) Epidemiological features of Moyamoya disease in Japan: findings from a nationwide survey. Clin Neurol Neurosurg 99(Suppl 2):S1–S5

    Article  PubMed  Google Scholar 

  26. Yonekawa Y, Ogata N, Kaku Y, Taub E, Imhof HG (1997) Moyamoya disease in Europe, past and present status. Clin Neurol Neurosurg 99(Suppl 2):S58–S60. doi: 10.1016/S0303-8467(97), 00042-5

    Article  PubMed  Google Scholar 

  27. Zipfel GJ, Fox DJJ, Rivet DJ (2005) Moyamoya disease in adults: the role of cerebral revascularization. Skull Base 1:27–41. doi:10.1055/s-2005-868161

    Article  Google Scholar 

Download references

Conflict of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Medical Center Mannheim, University of Heidelberg, Heidelberg, Germany

    C. F. Freyschlag, M. Seiz, R. W. Stier, G. A. Schubert, C. Thomé & P. Schmiedek

  2. Department of Neurosurgery, University Hospital Innsbruck, Innsbruck Medical University, Innsbruck, Austria

    C. F. Freyschlag, M. Seiz, G. A. Schubert & C. Thomé

  3. Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Heidelberg, Germany

    M. A. Brockmann & J. Scharf

Authors
  1. C. F. Freyschlag
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Seiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. A. Brockmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Scharf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. W. Stier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. A. Schubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Thomé
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. Schmiedek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. F. Freyschlag .

Editor information

Editors and Affiliations

  1. Dept. Neurosurgery, Kyoto National Hospital, Mukaihata-cho 1-1, Kyoto, 612-8555, Japan

    Tetsuya Tsukahara

  2. University Medical Center, Department of Neurosurgery, Rudolf Magnus Institute of Neuroscience, Heidelberglaan 100, Utrecht, 3508 GA, Netherlands

    Luca Regli

  3. Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Moorenstraße 5, Düsseldorf, 40225, Germany

    Daniel Hänggi

  4. Universitätsklinikum Düsseldorf, Institut für Radiologie, Moorenstraße 5, Düsseldorf, 40335, Germany

    Bernd Turowski

  5. Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Moorenstr. 5, Düsseldorf, 40225, Germany

    Hans-Jakob Steiger

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag/Wien

About this paper

Cite this paper

Freyschlag, C.F. et al. (2011). Effect of Mouth Opening on Bypass Function After Combined Revascularization for Moyamoya Disease. In: Tsukahara, T., Regli, L., Hänggi, D., Turowski, B., Steiger, HJ. (eds) Trends in Neurovascular Surgery. Acta Neurochirurgica Supplementum, vol 112. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0661-7_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-0661-7_7

  • Published:

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-0660-0

  • Online ISBN: 978-3-7091-0661-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation