Abstract
Background
Moyamoya disease is a vascular disorder characterized by progressive stenosis of the internal carotid artery. The presentation, progression, treatment options, and post-operative clinical outcomes for elderly (60 and older) Moyamoya patients have never been reported.
Methods
A retrospective analysis of all patients who were diagnosed with Moyamoya disease by the senior authors between 1991 and 2016 was performed. Patients who were 60 years or older at the time of surgery or last follow-up were further evaluated.
Results
Seventy patients were diagnosed with probable or definite Moyamoya disease during the study period (1991–2016). Eight patients (11.4 %; six females: two males; median age 63; range, 60–71 years) were found to be 60 years or older at the time of surgery or last follow-up and were included in the study. All patients had a modified Rankin scale (mRS) of either one or two (median 1) pre-operatively. Six patients (75 %) underwent surgical treatment on a total on seven hemispheres. Post-surgery, one patient had an improved mRS score, three had no changes, and two had worsening in their mRS scores. Both patients who did not undergo surgical interventions suffered from intra-parenchymal hemorrhages post-diagnosis.
Conclusions
Moyamoya disease is most commonly seen in young and middle-aged patients. Presentation in the elderly (defined as 60 years and older in this study) is rare, and has never been reported in the literature. In this study, both direct and indirect revascularization procedures demonstrated potential benefit in some of these patients, with stabilization of progressive symptoms.
Similar content being viewed by others
References
Abla AA, Gandhoke G, Clark JC, Oppenlander ME, Velat GJ, Zabramski JM, Albuquerque FC, Nakaji P, Wanebo JE (2013) Surgical outcomes for Moyamoya angiopathy at Barrow Neurological Institute with comparison of adult indirect encephaloduroarteriosynangiosis bypass, adult direct superficial temporal artery–to–middle cerebral artery bypass, and pediatric bypass: 154 revascularization surgeries in 140 affected hemispheres. Neurosurgery 73(3):430–439
Agarwalla PK, Stapleton CJ, Phillips MT, Walcott BP, Venteicher AS, Ogilvy CS (2014) Surgical outcomes following encephaloduroarteriosynangiosis in North American adults with moyamoya. J Neurosurg 121(6):1394–1400
Arias EJ, Dunn GP, Washington CW, Derdeyn CP, Chicoine MR, Grubb RL, Moran CJ, Cross DT, Dacey RG, Zipfel GJ (2014) Surgical revascularization in North American adults with Moyamoya phenomenon: long-term angiographic follow-up. J Stroke Cerebrovasc Dis 24(7):1597–1608
Baba T, Houkin K, Kuroda S (2008) Novel epidemiological features of moyamoya disease. J Neurol Neurosurg Psychiatry 79(8):900–904
Burke GM, Burke AM, Sherma AK, Hurley MC, Batjer HH, Bendok BR (2009) Moyamoya disease: a summary. Neurosurgical FOCUS 26(4):E11
Goda M, Isono M, Ishii K, Kamida T, Abe T, Kobayashi H (2004) Long-term effects of indirect bypass surgery on collateral vessel formation in pediatric moyamoya disease. J Neurosurg 100(2 Suppl Pediatrics):156–162
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. Clinical article. J Neurosurg 111(5):927–935
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(8):1342–1346
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(1):84–89
Kim T, Oh CW, Bang JS, Kim JE, Cho W-S (2016) Moyamoya disease: treatment and outcomes. J Stroke 18(1):21–30
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(4):527–531
Lähteenvuo J, Rosenzweig A (2012) Effects of aging on angiogenesis. Circ Res 110(9):1252–1264
Liu XJ, Zhang D, Wang S, Zhao YL, Teo M, Wang R, Cao Y, Ye X, Kang S, Zhao JZ (2015) Clinical features and long-term outcomes of moyamoya disease: a single-center experience with 528 cases in China. J Neurosurg 122(2):392–399
Nakashima H, Meguro T, Kawada S, Hirotsune N, Ohmoto T (1997) Long-term results of surgically treated moyamoya disease. Clin Neurol Neurosurg 99(Suppl 2):S156–S161
Natori Y, Ikezaki K, Matsushima T, Fukui M (1997) ‘Angiographic moyamoya’ its definition, classification, and therapy. Clin Neurol Neurosurg 99:S168–S172
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(3):625–630
Pollak L (2009) Moyamoya disease and moyamoya syndrome. N Engl J Med 361(1):98, author reply 98
Pollak L (2009) Moyamoya disease and moyamoya syndrome. N Engl J Med 361(1):98, author reply 98-98; author reply 98
Robertson RL, Burrows PE, Barnes PD, Robson CD, Poussaint TY, Scott RM (1997) Angiographic changes after pial synangiosis in childhood moyamoya disease. AJNR Am J Neuroradiol 18(5):837–845
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
Srinivasan J, Britz GW, Newell DW (2001) Cerebral revascularization for moyamoya disease in adults. Neurosurg Clin N Am 12(3):585–594, ix
Starke RM, Komotar RJ, Hickman ZL, Paz YE, Pugliese AG, Otten ML, Garrett MC, Elkind MS, Marshall RS, Festa JR, Meyers PM, Connolly ES (2009) Clinical features, surgical treatment, and long-term outcome in adult patients with moyamoya disease. Clinical article. J Neurosurg 111(5):936–942
Suzuki J, Kodama N (1983) Moyamoya disease—a review. Stroke J Cerebral Circ 14(1):104–109
Veeravagu A, Guzman R, Patil CG, Hou LC, Lee M, Steinberg GK (2008) Moyamoya disease in pediatric patients: outcomes of neurosurgical interventions. Neurosurg Focus 24(2):E16
Wakai K, Tamakoshi A, Ikezaki K, Fukui M, Kawamura T, Aoki R, Kojima M, Lin Y, Ohno Y (1997) Epidemiological features of moyamoya disease in Japan: findings from a nationwide survey. Clin Neurol Neurosurg 99(Suppl 2):S1–S5
Zafar SF, Bershad EM, Gildersleeve KL, Newmark ME, Calvillo E, Suarez JI, Venkatasubba Rao CP (2014) Adult moyamoya disease in an urban center in the United States is associated with a high burden of watershed ischemia. J Am Heart Assoc. doi:10.1161/JAHA.114.001123
Zipfel GJ, Fox DJ, Rivet DJ (2005) Moyamoya disease in adults: the role of cerebral revascularization. Skull Base: Official Journal of North American Skull Base Society 15(1):27–41
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Statement of human rights
IRB approval was obtained prior to beginning this retrospective analysis. For this type of study formal consent is not required.
Statement on the welfare of animals
This article does not contain any studies with animals performed by any of the authors.
Additional information
Comments
Moyamoya disease is a mysterious disease that has shown progressive stenosis of the internal carotid artery combined with "moyamoya" collateral vessels. The treatment for young-adult patients with moyamoya disease is established by using both direct and indirect revascularization surgery. However, elderly Moyamoya patients are rare, and the treatment strategy is not well known. This paper will be a good milestone for the treatment of elderly moyamoya patients.
Kenji Sugiu
Okayama, Japan
Rights and permissions
About this article
Cite this article
Gupta, R., M. Moore, J., Adeeb, N. et al. Clinical presentation, progression, and treatment outcomes of moyamoya disease in the elderly. Acta Neurochir 158, 2409–2414 (2016). https://doi.org/10.1007/s00701-016-2993-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-016-2993-z