Abstract
Background
The clinical and radiologic outcomes of symptomatic adult moyamoya disease (MMD) patients who have an occluded anastomosis immediately after bypass surgery are poorly studied. The clinical and angiographic outcomes of non-patent anastomosis in symptomatic adult MMD patients were retrospectively reviewed.
Methods
From August 2011 to November 2016, 31 revascularization surgeries, consisting of direct and indirect bypass, were performed on 29 adult MMD patients. Primary outcomes were evaluated based on the frequency of transient ischaemic attack (TIA) incidence and the recurrence of cerebral infarction and were assessed as improvement or worsening.
Results
Among 31 cases, computed tomography angiography (CTA) on the first day after surgery showed patent anastomosis in 20 hemispheres and non-patent anastomosis in 11 hemispheres. Follow-up conventional angiographies showed spontaneous recanalization of non-patent anastomosis in all occlusion cases. The incidence of TIA decreased in both the non-patent and the patent groups. Two newly developed cerebral infarctions were observed, which occurred in the patent group. Patients in the non-patent group also showed clinical improvement after surgery (p = 0.04), and no significant relationship was found between immediate postoperative patency and the primary outcome (p = 0.53).
Conclusions
In our series, regardless of patency immediately after bypass surgery, delayed recanalization and clinical improvement can be expected after bypass surgery for adult MMD.
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All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
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Informed consent was obtained from the study participants prior to their inclusion in the study.
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This article is part of the Topical Collection on Vascular Neurosurgery - Other
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Kim, S.H., Lee, H., Yoo, M. et al. Angiographic and clinical outcomes of non-patent anastomosis after bypass surgery in adult moyamoya disease. Acta Neurochir 161, 379–384 (2019). https://doi.org/10.1007/s00701-018-3733-3
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DOI: https://doi.org/10.1007/s00701-018-3733-3