Predictors and Clinical Features of Postoperative Hyperperfusion after Surgical Revascularization for Moyamoya Disease

Abstract OBJECTIVE AND IMPORTANCE The beneficial effects of surgical revascularization on rebleeding in moyamoya disease remain unclear. This report is intended to clarify the effects of surgical revascularization on peripheral artery aneurysms, which represent one of the causes of intracranial bleeding in moyamoya disease. CLINICAL PRESENTATION Findings for three female patients who experienced intracranial bleeding are presented. Cerebral angiography revealed that intracranial bleeding resulted from the rupture of peripheral artery aneurysms arising from dilated collateral vessels such as the lenticulostriate artery. INTERVENTION The patients successfully underwent superficial temporal artery-middle cerebral artery anastomosis combined with encephaloduromyoarteriosynangiosis. Angiography demonstrated obliteration of the peripheral artery aneurysms, together with the disappearance or decrease in caliber of the parent collateral arteries, after surgery. None of the patients experienced rebleeding during the follow-up period (up to 52 mo). CONCLUSION The results strongly suggest that surgical revascularization potentially improves cerebral circulation and decreases hemodynamic stress on collateral vessels, obliterating peripheral artery aneurysms.

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Abstract WP171: Surgical Strategy And Results Of Additional Bypass For Patients With Moyamoya Disease Refractory To Previous Surgery

Stroke ◽

10.1161/str.44.suppl_1.awp171 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Satoshi Kuroda ◽

Naoki Akioka ◽

Daina Kashiwazaki ◽

Hideo Hamada ◽

Naoya Kuwayama ◽

...

Keyword(s):

Disease Progression ◽

Moyamoya Disease ◽

Bypass Surgery ◽

Posterior Cerebral Artery ◽

Cerebral Hemodynamics ◽

Surgical Revascularization ◽

Surgical Strategies ◽

Cerebrovascular Events ◽

Before And After

Introduction —It is well known that surgical revascularization can improve cerebral hemodynamics and prevent further ischemic cerebrovascular events in moyamoya disease. However, a certain subgroup of patients repeats ischemic attacks even after surgery because of insufficient surgery or disease progression during follow-up periods. Hypothesis —Relevant designs and techniques in additional bypass surgery can resolve ischemic cerebrovascular events in patients with moyamoya disease refractory to previous bypass surgery. Methods —This study included totally 7 patients (9 hemispheres) with moyamoya disease refractory to previous bypass surgery. There were 5 children and 2 adults. They underwent previous bypass surgery in Japan and Europe 6 to 240 months before admission. Based on precise clinical and radiological analysis, cerebrovascular events were considered to occur because of insufficient bypass surgery in 5 patients and disease progression in the ipsilateral posterior cerebral artery in 2. Surgical strategies included wide craniotomy to cover the area where cerebral hemodynamics is still impaired and appropriate bypass procedures such as STA-MCA anastomosis, OA-PCA anastomosis, and indirect bypass. Using [123]I-IMP SPECT or [15]O-gas PET, cerebral hemodynamics was precisely examined before and after surgery Results —Postoperative course was uneventful and cerebral hemodynamics significantly improved in all 7 patients. Postoperative cerebral angiography revealed that additional bypass provided collateral blood flow to ischemic area before surgery. Ischemic cerebrovascular events rapidly resolved in 5 patients and gradually decreased in 2. Conclusion —This study strongly suggests adequate surgical design and procedures can resolve ischemic cerebrovascular events in patients with moyamoya disease refractory to previous bypass surgery.

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Clinical Features of Moyamoya Disease: An Overview

Moyamoya Disease Update ◽

10.1007/978-4-431-99703-0_16 ◽

2010 ◽

pp. 107-109 ◽

Cited By ~ 1

Author(s):

Yong-Seung Hwang

Keyword(s):

Clinical Features ◽

Moyamoya Disease

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Indocyanine green visualization of middle meningeal artery before craniotomy during surgical revascularization for moyamoya disease

Acta Neurochirurgica ◽

10.1007/s00701-016-3060-5 ◽

2017 ◽

Vol 159 (3) ◽

pp. 567-575 ◽

Cited By ~ 6

Author(s):

Nozomu Tanabe ◽

Shusuke Yamamoto ◽

Daina Kashiwazaki ◽

Naoki Akioka ◽

Naoya Kuwayama ◽

...

Keyword(s):

Indocyanine Green ◽

Moyamoya Disease ◽

Middle Meningeal Artery ◽

Surgical Revascularization ◽

Meningeal Artery

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Clinical Features of Moyamoya Disease in the United States

Stroke ◽

10.1161/01.str.29.7.1347 ◽

1998 ◽

Vol 29 (7) ◽

pp. 1347-1351 ◽

Cited By ~ 174

Author(s):

David Chiu ◽

Peter Shedden ◽

Patti Bratina ◽

James C. Grotta

Keyword(s):

United States ◽

Clinical Features ◽

Moyamoya Disease ◽

The United States

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Anticonvulsants for the Treatment of Hemichorea after Surgical Revascularization in Adolescent Patients with Moyamoya Disease

Annals of Child Neurology ◽

10.26815/acn.2020.00255 ◽

2021 ◽

Author(s):

Ga Hee Lee ◽

Dong Hyun Kim ◽

Hyeon Seon Park ◽

Woo Ri Jang ◽

Young Se Kwon

Keyword(s):

Moyamoya Disease ◽

Surgical Revascularization ◽

Adolescent Patients

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Disappearance of a ruptured distal anterior choroidal artery aneurysm following surgical revascularization for moyamoya disease with hemorrhagic onset

Nosotchu ◽

10.3995/jstroke.34.187 ◽

2012 ◽

Vol 34 (3) ◽

pp. 187-192 ◽

Cited By ~ 1

Author(s):

Keisuke Toyoda ◽

Shuji fukuda ◽

Shunsuke Ishizaka ◽

Tomonori Takeshita ◽

Kentaro Hayashi ◽

...

Keyword(s):

Moyamoya Disease ◽

Artery Aneurysm ◽

Anterior Choroidal Artery ◽

Surgical Revascularization ◽

Anterior Choroidal ◽

Choroidal Artery

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Clinical features of familial juvenile cases of moyamoya disease: analysis of patients treated in a single institute over a 28-year period

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.4.peds12420 ◽

2013 ◽

Vol 12 (2) ◽

pp. 175-180 ◽

Cited By ~ 3

Author(s):

Maki Mukawa ◽

Tadashi Nariai ◽

Yoshiharu Matsushima ◽

Kikuo Ohno

Keyword(s):

Clinical Features ◽

Moyamoya Disease ◽

Mr Angiography ◽

Posterior Cerebral Artery ◽

Clinical Course ◽

Intelligence Scale ◽

Familial Cases ◽

Sporadic Cases ◽

Tokyo Medical ◽

Disease Analysis

Object The authors compared the clinical features between familial and sporadic cases of moyamoya disease (MMD) by retrospectively analyzing data on patients with MMD registered in the database of Tokyo Medical and Dental University over a period of 28 years. Methods In total, 383 patients with hospital records at Tokyo Medical and Dental University from 1980 to 2007 were registered into the database. The data on all of these patients were retrospectively reviewed to clarify the occurrence of familial cases. Clinical features of child or adolescent patients (< 20 years of age) with MMD were compared between familial and sporadic cases in a subgroup of patients who were registered after 1995, initially diagnosed using MR angiography, and assessed using an intelligence scale. Results Familial occurrence was observed in 59 patients (15.4%) in 40 pedigrees. The clinical features of juvenile patients were analyzed in 124 patients, 22 (17.7%) of whom had familial histories. In comparison with the sporadic cases, patients with familial histories were significantly younger at onset (4.7 vs 6.6 years old), had significantly more cortical infarction (59.1% vs 25.5%), and had significantly more stenoocclusive lesions in the posterior cerebral artery (45.4% vs 24.5%). The rate of patients with intellectual disturbance (intelligence quotient < 75) was significantly larger in the familial cases (47.4%) than in the sporadic cases (17.8%). Conclusions This survey of the clinical features of familial MMD suggests that patients with familial MMD had a more serious clinical course in childhood than the sporadic MMD cases.

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