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Adult moyamoya after revascularization

  • Clinical Article - Vascular
  • Published:
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Abstract

Background

Although cerebral revascularization is an accepted treatment for moyamoya, the precise impact of direct or indirect bypass methods on subsequent event rates is infrequently addressed in adult cohorts.

Methods

We reviewed 45 consecutive adults with 69 hemispheres affected by moyamoya. We evaluated stroke and hemorrhage rates prior to and following revascularization.

Results

Direct revascularization was performed for 35 hemispheres (51 %) in 29 patients (64 %). The annual stroke, hemorrhage and overall event rates in this cohort diminished from 8.9 %, 2.0 %, and 11 % per hemisphere-year to 4.5 %, 0 %, and 4.5 % per hemisphere-year after treatment, respectively (p = 0.06). Excluding perioperative events, no events occurred over 41.1 hemisphere-years of follow-up (p = 0.0017). After a mean clinical follow-up period of 1.3 years, 72 % of patients were improved, 24 % the same, and 3 % worse in this cohort. Indirect revascularization was performed for 18 hemispheres (26 %) in 13 patients (29 %). The annual stroke, hemorrhage and overall event rates were 13 %, 0 %, and 13 % per hemisphere-year prior to treatment, and 6.8 %, 4.5 %, and 11 % per hemisphere-year after treatment, respectively (p = 0.67). Excluding perioperative events, the overall annual event rate was 7.1 % (p = 0.69). After a mean clinical follow-up of 2.7 years, 46 % of patients were improved, 38 % were the same and 15 % were worse.

Conclusion

Direct revascularization is the optimal choice to prevent subsequent events in adult patients with moyamoya. A favorable impact of indirect revascularization was less clear in this cohort, and should be reserved for patients with an inadequate donor vessel.

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References

  1. Bang JS, Kwon OK, Kim JE, Kang HS, Park H, Cho SY, Oh CW (2012) Quantitative angiographic comparison with the OSIRIS program between the direct and indirect revascularization modalities in adult moyamoya disease. Neurosurgery 70:625–632

    Article  PubMed  Google Scholar 

  2. Barnett HJM, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, Rankin RN, Clagett GP, Hachinski VC, Sackett DL, Thorpe KE, Meldrum HE, Spence JD (1998) Benefit of carotid endarterectomy in patients with moderate or severe stenosis. New Engl J Med 339:1415–1425

    Article  PubMed  CAS  Google Scholar 

  3. Chiu D, Shedden P, Bratina P, Grotta JC (1998) Clinical features of moyamoya disease in the United States. Stroke 29:1347–1351

    Article  PubMed  CAS  Google Scholar 

  4. Dusick JR, Gonzalez NR, Martin NA (2011) Clinical and angiographic outcomes from indirect revascularization surgery for moyamoya disease in adults and children: a review of 63 procedures. Neurosurgery 68:34–43

    Article  PubMed  Google Scholar 

  5. Fung LW, Thompson D, Ganesan V (2005) Revascularization surgery for paediatric moyamoya: a review of the literature. Childs Nerv Syst 21:358–364

    Article  PubMed  Google Scholar 

  6. Gross BA, Du R (2012) STA-MCA bypass. Acta Neurochir 154:1463–1467

    Article  Google Scholar 

  7. Guzman R, Lee M, Achrol A, Bell-Stephens T, Kelly M, Do HM, Marks MP, Steinberg GK (2009) Clinical outcome after 450 revascularization procedures for moyamoya disease. J Neurosurg 111:927–935

    Article  PubMed  Google Scholar 

  8. Hallemeier CL, Rich KM, Grubb RL, Chicoine MR, Moran CJ, Cross DT, Zipfel GJ, Dacey RG Jr, Derdeyn CP (2006) Clinical features and outcome in North American adults with moyamoya phenomenon. Stroke 37:1490–1496

    Article  PubMed  Google Scholar 

  9. Houkin K, Kamiyama H, Abe H, Takahashi A, Kuroda S (1996) Surgical therapy for adult moyamoya disease. Can surgical revascularization prevent the recurrence of intracerebral hemorrhage? Stroke 27:1342–1346

    Article  PubMed  CAS  Google Scholar 

  10. Ikezaki K, Fukui M, Inamura T, Kinukawa N, Wakai K, Ono Y (1997) The current status of the treatment for hemorrhagic type moyamoya disease based on a 1995 nationwide survey in Japan. Clin Neurol Neurosurg 99(Suppl 2):183–186

    Google Scholar 

  11. Karasawa J, Kikuchi H, Furuse S, Kawamura J, Sakaki T (1978) Treatment of moyamoya disease with STA-MCA anastomosis. J Neurosurg 49:679–688

    Article  PubMed  CAS  Google Scholar 

  12. Karasawa J, Touho H, Ohnishi H, Miyamoto S, Kikuchi H (1992) Long-term follow-up study after extracranial-intracranial bypass surgery for anterior circulation ischemia in childhood moyamoya disease. J Neurosurg 77:84–89

    Article  PubMed  CAS  Google Scholar 

  13. Kawaguchi S, Okuno S, Sakaki T (2000) Effect of direct arterial bypass on the prevention of future stroke in patients with the hemorrhagic variety of moyamoya disease. J Neurosurg 93:397–401

    Article  PubMed  CAS  Google Scholar 

  14. Kim SK, Wang KC, Kim IO, Lee DS, Cho BK (2002) Combined enceaphloduroarteriosynangiosis and bifrontal enceaphlogaleo(periosteal)synangiosis in pediatric moyamoya disease. Neurosurgery 50:88–96

    PubMed  Google Scholar 

  15. Kinugasa K, Mandai S, Kamata I, Sugiu K, Ohmoto T (1993) Surgical treatment of moyamoya disease: operative technique for encephalo-duro-arterio-myo-synangiosis, its follow-up, clinical results, and angiograms. Neurosurgery 32:527–531

    Article  PubMed  CAS  Google Scholar 

  16. Kobayashi E, Saeki N, Oishi H, Hirai S, Yamaura A (2000) Long-term natural history of hemorrhagic moyamoya disease in 42 patients. J Neurosurg 93:976–980

    Article  PubMed  CAS  Google Scholar 

  17. Kuriyama S, Kusaka Y, Fujimura M, Wakai K, Tamakoshi A, Hashimoto S, Tsuji I, Inaba Y, Yoshimoto T (2008) Prevalence and clinicoepidemiological features of moyamoya disease in Japan: findings from a nationwide epidemiological survey. Stroke 39:42–47

    Article  PubMed  Google Scholar 

  18. Kuroda S, Hashimoto N, Yoshimoto T, Iwasaki Y (2007) Radiological findings, clinical course, and outcome in asymptomatic moyamoya disease: results of multicenter survey in Japan. Stroke 38:1430–1435

    Article  PubMed  Google Scholar 

  19. Lee S, Kim D, Huh P, Yoo D, Lee T, Cho K (2012) Long-term follow-up results in 142 adult patients with moyamoya disease according to management modality. Acta Neurochir 154:1179–1187

    Article  Google Scholar 

  20. 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 24:E15

    Article  PubMed  Google Scholar 

  21. Miyamoto S (2004) Japan adult moyamoya trial group: study design for a prospective randomized trial of extracranial–intracranial bypass surgery for adults with moyamoya disease and hemorrhagic onset—the Japan adult moyamoya trial group. Neurol Med Chir (Tokyo) 44:218–219

    Article  Google Scholar 

  22. Mizoi K, Kayama T, Yoshimoto T, Nagamine Y (1996) Indirect revascularization for moyamoya disease: is there a beneficial effect for adult patients? Surg Neurol 45:541–548

    Article  PubMed  CAS  Google Scholar 

  23. Morioka M, Hamada J, Todaka T, Yano S, Kai Y, Ushio Y (2003) High-risk age for rebleeding in patients with hemorrhagic moyamoya disease: long-term follow-up study. Neurosurgery 52:1049–1055

    Article  PubMed  Google Scholar 

  24. Okada Y, Shima T, Nishida M, Yamane K, Yamada T, Yamanaka C (1998) Effectiveness of superficial temporal artery-middle cerebral artery anastomosis in adult moyamoya disease: cerebral hemodynamics and clinical course in ischemic and hemorrhagic varieties. Stroke 29:625–630

    Article  PubMed  CAS  Google Scholar 

  25. Saeki N, Nakazaki S, Kubota M, Yamaura A, Hoshi S, Sunada S, Sunami K (1997) Hemorrhagic type moyamoya disease. Clin Neurol Neurosurg 99(Suppl 2):S196–S201

    PubMed  Google Scholar 

  26. Sainte-Rose C, Oliveira R, Puget S, Beni-Adani L, Boddaert N, Thorne J, Wray A, Zerah M, Bourgeois M (2006) Multiple bur hole surgery for the treatment of moyamoya disease in children. J Neurosurg 105(6 Suppl):437–443

    PubMed  Google Scholar 

  27. Scott RM, Smith ER (2009) Moyamoya disease and moyamoya syndrome. N Engl J Med 360:1226–1237

    Article  PubMed  CAS  Google Scholar 

  28. Scott RM, Smith JL, Robertson RL, Madsen JR, Soriano SG, Rockoff MA (2004) Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis. J Neurosurg 100(2 Suppl Pediatrics):142–149

    PubMed  Google Scholar 

  29. Starke RM, Komotar RJ, Hickman ZL, Paz YE, Pugliese AG, Otten ML, Garrett MC, Elkind MS, Marshall RS, Festa JR, Meyers PM, Connolly ES Jr (2009) Clinical features, surgical treatment and long-term outcome in adult patients with moyamoya disease. J Neurosurg 111:936–942

    Article  PubMed  Google Scholar 

  30. Suzuki J, Takaku A (1969) Cerebrovascular “moyamoya” disease: disease showing abnormal net-like vessels in base of brain. Arch Neurol 20:288–299

    Article  PubMed  CAS  Google Scholar 

  31. Takeuchi S, Tsuchida T, Kobayashi K, Fukuda M, Ishii R, Tanaka R, Ito J (1983) Treatment of moyamoya disease by temporal muscle graft ‘encephalo-myo-synangiosis’. Childs Brain 10:1–15

    PubMed  CAS  Google Scholar 

  32. Wanifuchi H, Takeshita M, Izawa M, Aoki N, Kagawa M (1993) Management of adult moyamoya disease. Neurol Med Chir (Tokyo) 33:300–305

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurological Surgery, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

    Bradley A. Gross & Rose Du

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  1. Bradley A. Gross
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Correspondence to Rose Du.

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Gross, B.A., Du, R. Adult moyamoya after revascularization. Acta Neurochir 155, 247–254 (2013). https://doi.org/10.1007/s00701-012-1545-4

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  • DOI: https://doi.org/10.1007/s00701-012-1545-4

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