Disruption of Cortical Arterial Network is Associated with the Severity of Transient Neurologic Events After Direct Bypass Surgery in Adult Moyamoya Disease

OBJECTIVEThe purpose of this study was to evaluate treatment outcomes of future stroke prevention, perioperative complications, and angiographic revascularization in adults with symptomatic moyamoya disease (MMD) according to treatment modalities and surgical techniques.METHODSA systemic literature review was performed based on searches of the PubMed, Embase, and Cochrane Central databases. A fixed-effects model was used in cases of heterogeneity less than 50%. Publication bias was determined by Begg’s funnel plot, Egger’s test of the intercept, and the Begg and Mazumdar rank correlation test.RESULTSEleven articles were included in the meta-analysis. Bypass surgery significantly decreased the future stroke events compared with conservative treatments in adult MMD (odds ratio [OR] 0.301, p < 0.001). Direct bypass showed better future stroke prevention than indirect bypass (OR 0.494, p = 0.028). There was no meaningful difference in perioperative complications between direct and indirect bypass (OR 0.665, p = 0.176). Direct bypass was associated with better angiographic outcomes than indirect bypass (OR 6.832, p < 0.001).CONCLUSIONSBypass surgery can be effective in preventing future stoke events in adults with MMD. Direct bypass seems to provide better risk reduction with respect to stroke than indirect bypass in these patients.

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Hemodynamic study about cortical hyperintensity belt sign after direct bypass surgery for moyamoya disease

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2020.02.022 ◽

2020 ◽

Vol 74 ◽

pp. 124-129 ◽

Cited By ~ 2

Author(s):

Yushin Takemoto ◽

Takayuki Kawano ◽

Yuki Ohmori ◽

Yasuyuki Kaku ◽

Ken Uekawa ◽

...

Keyword(s):

Moyamoya Disease ◽

Bypass Surgery ◽

Direct Bypass ◽

Hemodynamic Study

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Pedicled temporoparietal fascial flap for combined revascularization in adult moyamoya disease

Journal of Neurosurgery ◽

10.3171/2018.5.jns18938 ◽

2019 ◽

Vol 131 (5) ◽

pp. 1501-1507 ◽

Cited By ~ 1

Author(s):

Kristine Ravina ◽

Robert C. Rennert ◽

Ben A. Strickland ◽

Mark Chien ◽

Joseph N. Carey ◽

...

Keyword(s):

Moyamoya Disease ◽

Venous Drainage ◽

Mass Effect ◽

Occlusive Disease ◽

Large Area ◽

Fascial Flap ◽

Indirect Revascularization ◽

Direct Bypass ◽

Adult Moyamoya Disease ◽

Cerebrovascular Occlusive Disease

Moyamoya disease (MMD) is a progressive, idiopathic cerebrovascular occlusive disease. Various revascularization techniques including direct, indirect, and combined microvascular bypasses have been described. This article presents a modified revascularization technique for MMD utilizing a pedicled temporoparietal fascial flap (TPFF) for combined revascularization. This technique combines a large area of coverage for indirect revascularization with the benefits of a direct bypass. The pedicled TPFF also benefits from intact venous drainage to minimize the risk of flap swelling that could result in complications from mass effect.

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Direct Bypass Surgery Vs. Combined Bypass Surgery for Hemorrhagic Moyamoya Disease: A Comparison of Angiographic Outcomes

Frontiers in Neurology ◽

10.3389/fneur.2018.01121 ◽

2018 ◽

Vol 9 ◽

Cited By ~ 7

Author(s):

Yahui Zhao ◽

Shaochen Yu ◽

Junlin Lu ◽

Lebao Yu ◽

Jiaxi Li ◽

...

Keyword(s):

Moyamoya Disease ◽

Bypass Surgery ◽

Direct Bypass

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Membrane Retraction Technique in Bypass Surgery for the Treatment of Adult Moyamoya Disease with Deep-Seated Recipient Artery

World Neurosurgery ◽

10.1016/j.wneu.2020.04.090 ◽

2020 ◽

Vol 139 ◽

pp. 294-297

Author(s):

Gang Wang ◽

Songtao Qi ◽

Guozhong Zhang ◽

Yunyu Wen ◽

Mingzhou Li ◽

...

Keyword(s):

Moyamoya Disease ◽

Bypass Surgery ◽

Recipient Artery ◽

Adult Moyamoya Disease

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Improvement in cognitive decline after indirect bypass surgery in adult moyamoya disease: implication of 15O-gas positron emission tomography

Annals of Nuclear Medicine ◽

10.1007/s12149-020-01473-8 ◽

2020 ◽

Vol 34 (7) ◽

pp. 467-475

Author(s):

Shoko Hara ◽

Takumi Kudo ◽

Shihori Hayashi ◽

Motoki Inaji ◽

Yoji Tanaka ◽

...

Keyword(s):

Positron Emission Tomography ◽

Cognitive Decline ◽

Moyamoya Disease ◽

Bypass Surgery ◽

Emission Tomography ◽

Positron Emission ◽

Adult Moyamoya Disease

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Abstract TP447: Edaravone Reduces Hyperperfusion-related Neurological Deficits After Direct Bypass in Adult Moyamoya Disease

Stroke ◽

10.1161/str.48.suppl_1.tp447 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Haruto Uchino ◽

Naoki Nakayama ◽

Ken Kazumata ◽

Kiyohiro Houkin

Keyword(s):

Moyamoya Disease ◽

Free Radical Scavenger ◽

Adult Patients ◽

Neurological Deficits ◽

Control Group ◽

Radical Scavenger ◽

Direct Bypass ◽

Adult Moyamoya Disease ◽

And Control ◽

Serial Measurements

Background and Purpose: Postoperative hyperperfusion-related transient neurological deficits (TNDs) are frequently observed in adult patients with moyamoya disease (MMD) who undergo direct bypass procedures. The present study evaluated the effect of the free radical scavenger edaravone on postoperative hyperperfusion in adult MMD. Methods: This study included 92 hemispheres in 72 adult patients who underwent direct bypass for MMD. Serial measurements of cerebral blood flow were conducted immediately after surgery and on postoperative days 2 and 7. In 40 hemispheres in 36 patients, edaravone (60 mg/day) was administered from the day of surgery until postsurgical day 7. The incidence of postoperative hyperperfusion and associated TNDs were compared with a control group that included 52 hemispheres in 36 patients. Results: Radiological hyperperfusion was observed in 28/40 (70.0%) and 39/52 (75.0%) hemispheres in the edaravone and control groups, respectively (P = 0.30). Hyperperfusion-related TNDs incidences were significantly lower in the edaravone group compared with the control group (12.5% vs. 32.7%, P = 0.024). Multivariate analysis demonstrated that edaravone administration (P = 0.009) and left-sided surgery (P = 0.037) were significantly correlated with hyperperfusion-related TNDs (odds ratios, 0.3 and 4.2, respectively). Conclusions: Perioperative administration of edaravone reduced the incidence of hyperperfusion-related TNDs after direct bypass procedures in adult patients with MMD.

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Analysis of Factors Related to Cerebral Infarction after Direct Bypass Surgery in Adults with Moyamoya Disease

Cerebrovascular Diseases ◽

10.1159/000504743 ◽

2020 ◽

Vol 49 (1) ◽

pp. 55-61

Author(s):

Yun Qian ◽

Bin Huang ◽

Zongmin Hu ◽

Jian Wang ◽

Peng Zhao ◽

...

Keyword(s):

Risk Factors ◽

Cerebral Infarction ◽

Clinical Data ◽

Moyamoya Disease ◽

Bypass Surgery ◽

Clinical Manifestations ◽

History Of ◽

Direct Bypass ◽

Nonoperative Side

Objective: High-risk factors of the patients with moyamoya disease (MMD) were analyzed to provide the basis for prediction and management of cerebral infarction after direct bypass surgery in adult MMD. Methods: 1. Retrospective analysis of clinical data was collected from adult MMD patients (n = 250) following superficial temporal artery-middle cerebral artery bypass surgery performed in our hospital from July 2013 to December 2017. Of the 250 patients, all underwent hemispherical bypass surgery, and bilateral surgery was performed on 14 patients. 2. Clinical data were analyzed based on sex, age, hypertension, diabetes, smoking history, history of alcohol use, presurgery cerebral infarction, transient ischemic attack, classification of clinical manifestations, clinical typing, Suzuki stage of surgical side, Suzuki stage of nonoperative side, preoperative Modified Rankin Scale (MRS), and lesions of the postoperative cycle or not. Results: 1. There were significant differences in classification of clinical manifestations, preoperative infarction, clinical typing, and Suzuki stage of nonoperative side (p < 0.05). 2. Logistic regression analysis showed that the independent factors affecting postoperative cerebral infarction were preoperative infarction and the Suzuki stage of nonoperative side (p < 0.05). The preoperative infarction (B 1.431, OR 4.184, 95% CI 1.217–14.382) and the Suzuki stage of nonoperative side (B 0.495, OR 1.640, 95% CI 1.207–2.227) were both risk factors. Conclusion: The possibility of a new cerebral infarction in postoperative patients with a history of cerebral infarction was greater. The Suzuki stages (I–VI) of the nonoperative side was higher and associated with an increased probability of cerebral infarction after surgery.

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