Anticonvulsants for the Treatment of Hemichorea after Surgical Revascularization in Adolescent Patients with 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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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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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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Abstract W P101: Surgical Revascularization Reverses Decreased Cerebral Oxygen Metabolism in Young Patients with Moyamoya Disease

Stroke ◽

10.1161/str.45.suppl_1.wp101 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Satoshi Kuroda ◽

Daina Kashiwazaki ◽

Kiyohiro Houkin

Keyword(s):

Cerebral Ischemia ◽

Moyamoya Disease ◽

Young Patients ◽

Oxygen Metabolism ◽

Cerebral Oxygen ◽

Surgical Revascularization ◽

Cerebral Oxygen Metabolism ◽

Positron Emission ◽

Pet Scans ◽

Parenchymal Damage

Purpose: This prospective study was aimed to evaluate the effects of surgical revascularization on cerebral oxygen metabolism in moyamoya disease. Methods: This study included totally 41 patients who underwent STA-MCA anastomosis and indirect bypass for moyamoya disease between 2000 and 2011. There were 12 children and 29 adults. Totally 67 hemispheres underwent surgery. MR imaging and 15O-gas positron emission tomography (PET) were performed before and 3 to 4 months after surgery. Hemodynamic and metabolic parameters were precisely quantified. Results: Preoperative PET scans revealed that cerebral metabolic rate for oxygen (CMRO2) was kept normal in 15 hemispheres (22%), but decreased in other 52 (78%). The incidence did not differ between pediatric and adult patients. Pronounced cerebral ischemia was observed in all hemispheres with decreased CMRO2. After surgery, CMRO2 value significantly improved to the normal level in 20 (38%) of 52 hemispheres, but did not change in other 32 (62%). Multivariate analysis showed that the predictors for postoperative CMRO2 normalization were patient’s age (younger than 40 years) and no parenchymal damage on MRI. Conclusion: These findings strongly suggest that cerebral oxygen metabolism is often depressed in response to dense and chronic cerebral ischemia in moyamoya disease. The phenomenon may be advantageous to protect the involved hemispheres against ischemia. Surgical revascularization may readily normalize oxygen metabolism in young patients without any parenchymal damage.

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Surgery for Moyamoya Disease in Children

Journal of Child Neurology ◽

10.1177/0883073819844854 ◽

2019 ◽

Vol 34 (9) ◽

pp. 517-529 ◽

Cited By ~ 4

Author(s):

Ramana Appireddy ◽

Manish Ranjan ◽

Bryce A. Durafourt ◽

Jay Riva-Cambrin ◽

Walter J. Hader ◽

...

Keyword(s):

Moyamoya Disease ◽

Hemorrhagic Stroke ◽

Pediatric Population ◽

Surgical Revascularization ◽

Surgical Options ◽

Revascularization Procedures ◽

Cerebrovascular Occlusive Disease ◽

The Brain ◽

Internal Carotid Arteries ◽

Selection Of

Moyamoya disease is a chronic progressive cerebrovascular occlusive disease of the terminal portion of the internal carotid arteries associated with an acquired abnormal vascular network at the base of the brain, often leading to ischemic or hemorrhagic stroke. Moyamoya disease is a relatively common cause of pediatric stroke with a specific racial and well-identified clinical and imaging phenotype. Moyamoya disease is more prevalent in East Asian countries compared with other geographic regions with a higher incidence of familial cases and clinically more aggressive form. Moyamoya disease is one of the few causes of stroke that is amenable to effective surgical revascularization treatment. There are various surgical options available for revascularization, including the direct, indirect, or combined bypass techniques, each with variable responses. However, due to the heterogeneity of the diseases, different clinical course, geographical variables associated with the disease, and availability of a wide variety of surgical revascularization procedures, optimal selection of a surgical candidate and the surgical technique becomes challenging, particularly in the pediatric population. This brief review presents pertinent literature of clinical options for the diagnosis and surgical treatment of moyamoya disease in children.

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Clinical Characteristics and Long-Term Outcome of Headaches Associated With Moyamoya Disease in the Chinese Population—A Cohort Study

Frontiers in Neurology ◽

10.3389/fneur.2020.605636 ◽

2020 ◽

Vol 11 ◽

Author(s):

Bin Gao ◽

Kaijiang Kang ◽

Jia Zhang ◽

Dong Zhang ◽

Xingquan Zhao

Keyword(s):

Conservative Treatment ◽

Moyamoya Disease ◽

Chinese Population ◽

Chinese Patients ◽

Surgical Revascularization ◽

Term Outcome ◽

Long Term Outcome ◽

Long Term Follow Up

Background: Headache associated with Moyamoya disease (HAMD) in the Chinese population is not well-described. The long-term outcome of surgical revascularization and natural course of HAMD has not been disclosed either.Methods: A headache screening questionnaire in China based on the ICHD2 and a face-to-face interview performed by an experienced neurologist were used to investigate headache characteristics and frequency and pain intensity in the 3 months before admission, and a telephone interview was used for the follow-up of a large cohort of 119 Chinese patients with HAMD.Results: Headache intensity was rated as scores of 5.9 ± 2.0 on a visual analog scale (VAS), ranging from 0 to 10, in the 3 months before admission. Forty-six patients (38.6%) were categorized as having migraine-like headaches, 29 patients (24.3%) were categorized as having tension type-like headaches, and 44 patients (36.9%) had a combination of both. The majority of patients had migraine-like headaches (n = 34, 73.9%) with a migrainous aura. Both the frequency and intensity of the headache improved significantly in patients treated with surgical revascularization (n = 96, 80.7%) or the conservative treatment (n = 23, 19.3%) in a long-term follow-up.Conclusion: HAMD frequently presented with a migraine-like headache (75.5% in total). A tension type headache was present in 60.9% of patients. The symptom of dizziness is common in patients with HAMD (60.5%), and 19 of them (26.4%) met the diagnose of vestibular migraine. Both intensity and frequency of HAMD show a trend of spontaneous remission in a long-term follow-up, and there is no difference in long-term outcomes of HAMD between surgical revascularization and conservative treatment, which indicates that the effect of bypass intervention on HAMD may be a placebo effect.

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Effective Surgical Revascularization Improves Cerebral Hemodynamics and Resolves Headache in Pediatric Moyamoya Disease

World Neurosurgery ◽

10.1016/j.wneu.2012.08.005 ◽

2013 ◽

Vol 80 (5) ◽

pp. 612-619 ◽

Cited By ~ 13

Author(s):

Masahito Kawabori ◽

Satoshi Kuroda ◽

Naoki Nakayama ◽

Kenji Hirata ◽

Toru Shiga ◽

...

Keyword(s):

Moyamoya Disease ◽

Cerebral Hemodynamics ◽

Surgical Revascularization

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Clinical Implications of the “Brush Sign” in Susceptibility-Weighted Imaging for Moyamoya Disease

Cerebrovascular Diseases ◽

10.1159/000511936 ◽

2021 ◽

pp. 1-9

Author(s):

Junlin Lu ◽

Yahui Zhao ◽

Mingtao Li ◽

Li Ma ◽

Yu Chen ◽

...

Keyword(s):

Moyamoya Disease ◽

Perioperative Management ◽

Clinical Implications ◽

Susceptibility Weighted Imaging ◽

Surgical Revascularization ◽

Surgical Risk ◽

Independent Risk Factors ◽

High Intensity Signal ◽

Revascularization Surgery ◽

Deep Medullary Veins

Objective: Infarction is one of the most common postoperative complications after surgical revascularization for moyamoya disease (MMD). Increased conspicuity of deep medullary veins (DMVs) on susceptibility-weighted imaging (SWI), known as “brush sign,” could predict the severity of MMD. This study aimed to reveal the features of the “brush sign” in preoperative SWI and to verify its relationship to postoperative infarction. Methods: Consecutive patients with MMD who had undergone cerebral revascularization surgery were included. Routine preoperative SWI was performed. The “brush sign” was defined according to the number of the conspicuous DMVs > 5 detected on SWI. Postoperative infarctions were defined as the high-intensity signal on postoperative DWI images, with or without neurologic deficits. The modified Rankin scale (mRS) was applied to evaluate the prognosis of patients. Results: In the enrolled 100 hemispheres, 35 were presented with the “brush sign.” Patients with ischemic onset manifestation and previous infarction history tended to present with the “brush sign.” Multivariate analysis showed that the “brush sign” (OR 13.669; 95% CI, 1.747–106.967, p = 0.013) and decreased rCBF (OR 6.050; 95% CI, 1.052–34.799, p = 0.044) were independent risk factors of postoperative infarction. Besides, the “brush sign” showed a significant correlation with a higher mRS score at discharge (p = 0.047). Conclusion: The findings strongly suggest that the presence of the “brush sign” preoperatively can be a predictor of infarction after surgical revascularization for ischemic MMD. It may contribute to an improved surgical result through focused perioperative management based on appropriate surgical risk stratification.

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