Epilepsy After Bypass Surgery in Adult Moyamoya Disease

Neurosurgery ◽  
2011 ◽  
Vol 68 (5) ◽  
pp. 1227-1232 ◽  
Author(s):  
Sung-Chul Jin ◽  
Chang Wan Oh ◽  
O-Ki Kwon ◽  
Gyojun Hwang ◽  
Jae Seung Bang ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Multivariable Analysis ◽  
Adult Patients ◽  
Neurological Deficits ◽  
Recipient Artery ◽  
Generalized Estimation Equation ◽  
Postoperative Seizure ◽  
Direct Bypass ◽  
Adult Moyamoya Disease ◽  
Revascularization Surgery

Abstract BACKGROUND: Postoperative seizure, well-known in association with other pathologies, has been rarely discussed in adult moyamoya disease. OBJECTIVE: We evaluated postoperative seizures in adult patients with moyamoya undergoing revascularization surgery. METHODS: From 2001 to 2007, 43 adult patients with moyamoya disease underwent 53 revascularization surgeries, consisting of direct bypass with or without indirect bypass. Incidence and profile of postoperative seizures were investigated, with evaluation of influencing factors. Multivariable analysis using a generalized estimation equation was performed to determine which factors were related to postoperative seizure. RESULTS: Seizures developed in 10 sides (18.9%) after revascularization for moyamoya disease, including immediate (<24 hours, n = 0), early (1–7 days, n = 5), late (8–30 days, n = 0), and delayed seizures (≥1 month, n = 7). Early and subsequent delayed seizures developed in the same lesions in 2 patients. Seizures developed only in the patients with combined direct and indirect revascularization. Postoperative temporary neurological deficits with imaging abnormalities were significantly related to postoperative nondelayed seizures (P = .02). Delayed seizures were significantly different according to the location of the recipient artery (P = .03), especially with the frontal branches. By multivariable analysis, revascularization using frontal branches trended toward increased incidence of delayed postoperative seizure, with adjusted odds ratio of 13.78 (95% confidence interval, 1.7-114.1). CONCLUSION: In adult patients with moyamoya disease, the incidence of delayed postoperative seizure seems to be higher than that of other pathologies. The delayed, pronounced formation of synangiosis in moyamoya disease may be related to the development of such delayed postoperative seizures, especially when the location of the recipient artery is frontal.

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

Stroke ◽  
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.

dl-3-n-butylphthalide for alleviation of neurological deficit after combined extracranial-intracranial revascularization for moyamoya disease: a propensity score–matched analysis

2020 ◽  
Vol 132 (2) ◽  
pp. 421-433 ◽  
Author(s):  
Zongze Li ◽  
Junlin Lu ◽  
Li Ma ◽  
Chunxue Wu ◽  
Zongsheng Xu ◽  
...  
Keyword(s):  
Propensity Score ◽  
Moyamoya Disease ◽  
Neurological Deficit ◽  
Multivariable Analysis ◽  
Neurological Function ◽  
Neurological Deficits ◽  
Perioperative Stroke ◽  
Number Of Patients ◽  
Significant Difference ◽  
Revascularization Surgery

OBJECTIVEPostoperative neurological deficits impair the overall outcome of revascularization surgery for patients with moyamoya disease (MMD). dl-3-n-butylphthalide (NBP) is approved for the treatment of ischemic stroke in China. This pilot study evaluated the effect of NBP on perioperative stroke and neurological deficits in patients with MMD.METHODSThe authors studied cases in which patients underwent combined revascularization surgery for MMD at their institution, with or without NBP administration. The overall study group included 164 patients (213 surgically treated hemispheres), including 49 patients who received NBP (25 mg twice daily) for 7 postoperative days. The incidence of perioperative stroke and transient neurological deficit (TND) and the severity of neurological deficits were compared between 49 propensity score–matched case pairs with or without NBP treatment. Subgroup analyses by type of onset and preoperative neurological status were also performed to determine specific characteristics of patients who might benefit from NBP administration.RESULTSIn the overall cohort, baseline characteristics differed with respect to preoperative stroke and modified Rankin Scale (mRS) score between patients who received NBP and those who did not receive it. In the 49 propensity score–matched pairs, postoperative stroke was observed in 11 patients and TND occurred in 21 patients, with no significant difference in incidence between the 2 groups. However, the TND was less severe in the NBP-treated group (p = 0.01). At 1 month after surgery, the neurological outcome was more favorable (p = 0.001) and the disability-free recovery rate was higher in patients with NBP treatment (p < 0.001). The number of patients who experienced an improved neurological function, compared to preoperative function, as measured by mRS, was greater in the NBP group than in the no-NBP group (p < 0.001). Multivariable analysis revealed that NBP administration was associated with decreased severity of TND (OR 0.28, p = 0.02), improved neurological function (OR 65.29, p = 0.04), and lower postoperative mRS score (OR 0.06, p < 0.001). These beneficial effects of NBP remained significant in ischemic type MMD and patients with preoperative mRS scores of 2 or greater.CONCLUSIONSPostoperative administration of NBP may alleviate perioperative neurological deficits after revascularization surgery for MMD, especially in patients with ischemic MMD and unfavorable preoperative status. The results of this study suggest that randomized controlled trials to assess the potential benefit of NBP in patients with MMD may be warranted.

scholarly journals Edaravone Reduces Hyperperfusion-Related Neurological Deficits in Adult Moyamoya Disease

Stroke ◽  
2016 ◽  
Vol 47 (7) ◽  
pp. 1930-1932 ◽  
Author(s):  
Haruto Uchino ◽  
Naoki Nakayama ◽  
Ken Kazumata ◽  
Satoshi Kuroda ◽  
Kiyohiro Houkin
Keyword(s):  
Moyamoya Disease ◽  
Neurological Deficits ◽  
Adult Moyamoya Disease

scholarly journals Pedicled temporoparietal fascial flap for combined revascularization in adult moyamoya disease

2019 ◽  
Vol 131 (5) ◽  
pp. 1501-1507 ◽  
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.

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

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

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

2017 ◽  
Vol 100 ◽  
pp. 311-315 ◽  
Author(s):  
Yusuke Egashira ◽  
Keita Yamauchi ◽  
Yukiko Enomoto ◽  
Noriyuki Nakayama ◽  
Shinichi Yoshimura ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Arterial Network ◽  
Direct Bypass ◽  
Adult Moyamoya Disease

scholarly journals Clinical implications of the cortical hyperintensity belt sign in fluid-attenuated inversion recovery images after bypass surgery for moyamoya disease

2017 ◽  
Vol 126 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Eika Hamano ◽  
Hiroharu Kataoka ◽  
Naomi Morita ◽  
Daisuke Maruyama ◽  
Tetsu Satow ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Vasogenic Edema ◽  
Posterior Part ◽  
The Other ◽  
Neurological Deficits ◽  
Other Hand ◽  
Direct Bypass

OBJECTIVE Transient neurological symptoms are frequently observed during the early postoperative period after direct bypass surgery for moyamoya disease. Abnormal signal changes in the cerebral cortex can be seen in postoperative MR images. The purpose of this study was to reveal the radiological features of the “cortical hyperintensity belt (CHB) sign” in postoperative FLAIR images and to verify its relationship to transient neurological events (TNEs) and regional cerebral blood flow (rCBF). METHODS A total of 141 hemispheres in 107 consecutive patients with moyamoya disease who had undergone direct bypass surgery were analyzed. In all cases, FLAIR images were obtained during postoperative days (PODs) 1–3 and during the chronic period (3.2 ± 1.13 months after surgery). The CHB sign was defined as an intraparenchymal high-intensity signal within the cortex of the surgically treated hemisphere with no infarction or hemorrhage present. The territory of the middle cerebral artery was divided into anterior and posterior parts, with the extent of the CHB sign in each part scored as 0 for none; 1 for presence in less than half of the part; and 2 for presence in more than half of the part. The sum of these scores provided the CHB score (0–4). TNEs were defined as reversible neurological deficits detected both objectively and subjectively. The rCBF was measured with SPECT using N-isopropyl-p-[123I]iodoamphetamine before surgery and during PODs 1–3. The rCBF increase ratio was calculated by comparing the pre- and postoperative count activity. RESULTS Cortical hyperintensity belt signs were detected in 112 cases (79.4%) and all disappeared during the chronic period. Although all bypass grafts were anastomosed to the anterior part of the middle cerebral artery territory, CHB signs were much more pronounced in the posterior part (p < 0.0001). TNEs were observed in 86 cases (61.0%). Patients with TNEs showed significantly higher CHB scores than those without (2.31 ± 0.13 vs 1.24 ± 0.16, p < 0.0001). The CHB score, on the other hand, showed no relationship with the rCBF increase ratio (p = 0.775). In addition, the rCBF increase ratio did not differ between those patients with TNEs and those without (1.15 ± 0.033 vs 1.16 ± 0.037, p = 0.978). CONCLUSIONS The findings strongly suggest that the presence of the CHB sign during PODs 1–3 can be a predictor of TNEs after bypass surgery for moyamoya disease. On the other hand, presence of this sign appears to have no direct relationship with the postoperative local hyperperfusion phenomenon. Vasogenic edema can be hypothesized as the pathophysiology of the CHB sign, because the sign was transient and never accompanied by infarction in the present series.

Abstract TP449: Clinical and Angiographic Outcomes From Combined Direct and Indirect Bypass in Adult Patients with Moyamoya Disease: A Retrospective Study of 76 Procedures

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jinbing Zhao ◽  
Hongyi Liu ◽  
Yuanjie Zou ◽  
Shengxue He
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Perfusion ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Vessel Diameter ◽  
Adult Patients ◽  
Neurological Dysfunction ◽  
Neurological Deficits ◽  
Main Trunk

Objective: Surgical revascularization is the mainstay of treatment for moyamoya patients. This study was to evaluate the progonosis of combined direct and indirect procedure for moyamoya disease patients. Methods: 76 cerebral hemispheres from 64 adult moyamoya patients undergoing combined superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and encephalo-duro-myo-synangiosis (EDMS) were reviewed retrospectively. The mean follow-up period was 23±14m (6m-70m). CT or MR perfusion and Digital subtraction angiography (DSA) were performed for preoperative diagnosis and postoperative evaluation of cerebral perfusion and revascularization. mRS score, angiographic collateralization score, vessel diameter were recorded to measure neurological dysfunction, revascularization area and vascular compensatory effect respectively. Results: Among the 64 MMD patients, 69 hemispheres received combined direct and indirect operations; 7 hemispheres only received indirect operations. During our follow-up periods, neurological deficits of 57/64 patients (89.1%) were partially alleviated. mRS was significantly decreased after operations not only in all patients, but also in stroke subgroup or hemorrhage subgroup. Generally, good revascularization was established in most of the patients by combined bypass. 92.1% (70/74) sides was scored 2 and 77.6% (59/74) sides was scored 3 determined by angiographic collateralization score. Compared to the preoperative situations (2.60±0.65mm), the calibers of STA main trunk increased profoundly in at postoperative 10 days (3.32±1.05mm, p<0.05 versus pre-operation), and shrinked back to preoperative status at 6 months (2.24±1.00mm, p>0.05 versus pre-operation) and 12 months (2.36±0.73mm, p>0.05 versus pre-operation). Conclusion: Our findings strongly suggested that combined STA-MCA bypass and EDMS provided efficient revascularization and excellent results in preventing strokes and hemorrhage in adult patients. The direct STA-MCA bypass provided early augmentation of cerebral perfusion, whereas the indirect EDMS provided a more durable long-term revascularization, indicating a complementary relationship between the two revascularization methods.

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