Surgical management of moyamoya disease

2009 ◽  
Vol 26 (4) ◽  
pp. E7 ◽  
Author(s):  
Ali A. Baaj ◽  
Siviero Agazzi ◽  
Zafar A. Sayed ◽  
Maria Toledo ◽  
Robert F. Spetzler ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Surgical Options ◽  
Direct Bypass ◽  
Stenotic Vessel ◽  
Internal Carotid Arteries

Moyamoya disease (MMD) is a progressive, occlusive disease of the distal internal carotid arteries associated with secondary stenosis of the circle of Willis. Symptoms include ischemic infarcts in children and hemorrhages in adults. Bypass of the stenotic vessel(s) is the primary surgical treatment modality for MMD. Superficial temporal artery-to-middle cerebral artery bypass is the most common direct bypass method. Indirect techniques rely on the approximation of vascularized tissue to the cerebral cortex to promote neoangiogenesis. This tissue may be in the form of muscle, pericranium, dura, or even omentum. This review highlights the surgical options available for the treatment of MMD.

Embolization of a Superficial Temporal Artery to Middle Cerebral Artery Bypass: Case Report

Neurosurgery ◽  
1983 ◽  
Vol 12 (3) ◽  
pp. 342-345 ◽  
Author(s):  
Frances K. Conley
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Bilateral Carotid ◽  
History Of ◽  
Internal Carotid Arteries ◽  
Bilateral Carotid Artery

Abstract This case history of a man with bilateral carotid artery occlusions presents angiographic documentation of the embolization of a superficial temporal-middle cerebral artery bypass. The embolic source was thrombotic and/or atheromatous debris that had collected in the persistent stump of one of the occluded internal carotid arteries.

Do Direct Bypasses Really Resolve Capillary Vessels in Moyamoya Disease? Delayed Hemorrhage Potentially Relevant to Direct Bypasses: A Pathological Investigation

2020 ◽  
Vol 55 (4) ◽  
pp. 203-209
Author(s):  
Seiichiro Eguchi ◽  
Yasuo Aihara ◽  
Kentaro Chiba ◽  
Koji Yamaguchi ◽  
Akitsugu Kawashima ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Surgical Revascularization ◽  
Delayed Hemorrhage ◽  
History Of ◽  
Hematoma Growth ◽  
Capillary Telangiectasia ◽  
Direct Bypass ◽  
Internal Carotid Arteries

<b><i>Objective:</i></b> Moyamoya disease is a chronic but progressive obliterative cerebrovascular disease of bilateral internal carotid arteries (ICAs) causing hemorrhagic or ischemic cerebral strokes. Surgical revascularization has the potential for resolving the capillary vessels, but the effect on the occlusive ICA and the moyamoya vessels after a direct bypass remains unclear. <b><i>Patient:</i></b> A 2-year-old girl with a history of repeated transient ischemic attacks and direct bypasses but demonstrating improvement and associated anomaly is reported. A year and a half later, after a bilateral revascularization, an intracerebral capsulized hematoma growth was identified, and it was removed surgically. Neovascularization including many microvessels similar to capillary telangiectasia were identified by pathological investigation despite the reduction of moyamoya vessels on the repeated angiograms after the revascularization surgeries. In the present case, proliferation of capillary vessels was clearly confirmed by direct bypasses. <b><i>Conclusion:</i></b> There is no doubt that direct bypasses prevent further ischemic stroke by improving cerebral blood flow. However, they may result in failure in reducing the load of moyamoya vessels, albeit decreasing the potential risk of hemorrhagic strokes.

A 1-Donor 2-Recipient Superficial Temporal Artery-Middle Cerebral Artery Bypass for Moyamoya Syndrome: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Nickalus R Khan ◽  
Jacques J Morcos
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Surgical Anatomy ◽  
Large Area ◽  
Ischemic Disease ◽  
Near Occlusion ◽  
Direct Bypass

Abstract We present the case of a 34-yr-old male who suffered repeated ischemic events resulting in right-sided weakness. He was found to have left M1 segment near occlusion on angiography with a large area of uncompensated hypoperfusion. The patient underwent a direct superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Direct bypass in the acute setting of ischemia has been previously described.1-5 Moyamoya ischemic disease can be treated with either direct or indirect surgical revascularization. There have been several techniques developed for direct bypasses in moyamoya ischemic disease. These include the standard 1-donor 1-recipient (1D1R) end-to-side (ES) bypass, the “double-barrel” 2-donor 2-recipient (2D2R) ES bypass, and the more recently developed 1-donor 2-recipient (1D2R)6,7 utilizing both an ES and a side-to-side (SS) bypass with a 1-donor vessel. The case presentation, surgical anatomy, decision-making, operative nuances, and postoperative course and outcome are reviewed. The patient gave verbal consent for participating in the procedure and surgical video.

scholarly journals Characteristics of Moyamoya Disease in the Older Population: Is It Possible to Define a Typical Presentation and Optimal Therapeutical Management?

2021 ◽  
Vol 10 (11) ◽  
pp. 2287
Author(s):  
Ignazio G. Vetrano ◽  
Anna Bersano ◽  
Isabella Canavero ◽  
Francesco Restelli ◽  
Gabriella Raccuia ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Perioperative Complications ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Brain Perfusion ◽  
Temporal Artery ◽  
Minimal Invasive ◽  
Operative Complications ◽  
Surgical Options ◽  
Post Operative Complications

Whereas several studies have been so far presented about the surgical outcomes in terms of mortality and perioperative complications for elderly patients submitted to neurosurgical treatments, the management of elderly moyamoya patients is unclear. This review aims to explore the available data about the clinical manifestation, characteristics, and outcome after surgery of older patients with moyamoya arteriopathy (MA). We found only two articles strictly concerning elderly patients with MA. We have also evaluated other reported adult series of moyamoya patients, including elderly cases in their analysis. Patients with MA above 50 years old may be considered a peculiar subset in which patients are often presenting with ischemic symptoms and a higher Suzuki grade. Conservative treatment may be proposed in asymptomatic or stable cases due to their fragility and possible increase of post-operative complications, while the best surgical options in symptomatic cases are still under investigation, although we believe that a minimal invasive superficial temporal artery—middle cerebral artery bypass could be considered the treatment of choice for the immediate effect on brain perfusion with a limited rate of post-operative complications.

scholarly journals Combining Internal Carotid Artery Occlusion with Intermediate-Flow Bypass for Treating Large-Giant Cavernous Sinus Segment Aneurysms: Case Report and Review of Literature

2019 ◽  
Vol 16 (1) ◽  
pp. 42-47
Author(s):  
Robin Bhattarai ◽  
Chuan Chen ◽  
Chao Feng Liang ◽  
Teng Chao Huang ◽  
Hui Wang ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Treatment Effectiveness ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Balloon Occlusion ◽  
The Right

We summarize the treatment effectiveness and experience of a patient who underwent internal carotid balloon occlusion combined with Intermediate-flow bypass as a treatment for large-giant cavernous sinus segment internalcarotid artery (CS ICA) aneurysms. A 62-year-old woman presented with a large aneurysm on the right side of the cavernoussinus with dizziness for about two years and Oculomot or nerve palsy. An extra cranial intracranial (EC-IC) Intermediate-flow by pass using a radial artery bypass graft (RABG) and proximal balloon occlusion of the Right ICA were performed. The patient experienced no new neurologic deficit after this treatment. Follow up radiologic evaluations using Computed Tomography Angiography revealed complete aneurysm occlusion. For patients with large-giant CS ICA aneurysms, treatment of ICA occlusion combined with Intermediate-flow superficial temporal artery-Radial artery-middle cerebralartery bypass surgery was an effective and safe surgical strategy.

Unilateral sudden hearing loss as the first presenting symptom of moyamoya disease

2013 ◽  
Vol 127 (2) ◽  
pp. 196-199 ◽  
Author(s):  
L-S Tseng ◽  
S-D Luo
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Moyamoya Disease ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Cerebral Arteries ◽  
Sudden Onset ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Internal Carotid Arteries

AbstractObjective:We describe a rare case of sudden onset of unilateral sensorineural hearing loss occurring as the first symptom of moyamoya disease, which is characterised by progressive stenosis of the intracranial internal carotid arteries and their proximal anterior cerebral arteries and middle cerebral arteries.Method:Case report and review of the world literature regarding moyamoya disease with hearing loss.Results:The reported patient had moyamoya disease that initially presented as sudden, unilateral sensorineural hearing loss. Magnetic resonance imaging showed occlusion of the anterior cerebral, middle cerebral and distal internal carotid arteries bilaterally. The possible mechanism of this patient's sudden sensorineural hearing loss may have been vascular occlusion resulting from thrombotic narrowing or blockage by plaque.Conclusion:The described patient represents the first reported case of sudden onset, unilateral sensorineural hearing loss occurring as the first symptom of moyamoya disease. The possibility of a vascular lesion such as moyamoya disease should be considered in patients with sudden sensorineural hearing loss, especially children, young adults and Asian patients. Due to this disease's poor outcome, early diagnosis and treatment are important to prevent stroke.

scholarly journals Moyamoya in Hispanics: not only in Japanese

2014 ◽  
Vol 6 (2) ◽  
Author(s):  
Sarmad Said ◽  
Chad J. Cooper ◽  
Haider Alkhateeb ◽  
Juan M. Galvis ◽  
German T. Hernandez ◽  
...  
Keyword(s):  
Cigarette Smoke ◽  
Moyamoya Disease ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Prolonged Survival ◽  
Moyamoya Syndrome ◽  
Characteristic Appearance ◽  
Hispanic Patients ◽  
Collateral Vessels ◽  
Internal Carotid Arteries

Moyamoya disease was first described in 1957 as <em>hypoplasia of the bilateral internal carotid arteries</em>, the characteristic appearance of the associated network of abnormally dilated collateral vessels on angiography was later likened to something hazy, like a puff of cigarette smoke, which, in Japanese, is <em>moyamoya</em>. This paper describes two cases of moyamoya presentations, including moyamoya disease and moyamoya syndrome. Moyamoya may rarely occur in North American Hispanic patients. The presentation can vary significantly and ranges bwtween fulminant outcome and prolonged survival. Awareness about moyamoya and its different presentations may be beneficial for the patients and can improve the outcome.

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