Current Surgical Options for Moyamoya Disease

Abstract

Moyamoya disease (MMD) is a cerebrovascular disease of unknown etiology characterized by stenotic and occlusive arterial changes of the anterior circulation, with subsequent proliferative development of arterial collateralization. In spite of there being limited understanding of the clear etiology of MMD, surgical revascularization for MMD is considered the standard treatment to prevent further stroke. While the use of surgical revascularization to prevent future hemorrhagic stroke in MMD is still controversial, it is considered effective in the case of ischemic stroke. This article presents a review of the current surgical management of MMD based on an analysis of the most recent data from peer-reviewed articles and opinion based on personal experience with surgical revascularization in the treatment of MMD.

RNF213 gene silencing upregulates transforming growth factor β1 expression in bone marrow‑derived mesenchymal stem cells and is involved in the onset of Moyamoya disease

“…Epidemiological analyses have reported distinctive features of familial Moyamoya disease, with the male to female ratio at 5.0 in familial cases ( 42 ). Surgical treatment constitutes the main available treatment for MMD with no pharmacological options currently available ( 43 ). In a previous study that included 10 years of follow-ups, antiplatelet medications were not found to affect the incidence of cerebral infarction in patients with Moyamoya disease ( 44 ).…”

Silent Moyamoya disease - A rare case report

“…Surgical revascularization has been offered in ischemic MMD to augment cerebral blood flow and prevent future ischemic events. While in hemorrhagic MMD, theoretically, it is believed that bypass procedures prevent the recurrent hemorrhages by lowering the long-term hemodynamic stress on the collateral vasculature [13] . In a study on asymptomatic MMD, 7 of 34 patients suffered an ischemic stroke, TIA, or hemorrhagic stroke, who did not undergo revascularization surgery.…”

Moyamoya Disease in Adult: A Clinical Case

“…O caso apresentado descreve os eventos isquémicos como forma de apresentação da doença de Moyamoya, resultado da hipoperfusão provocada pela progressiva esteno-oclusão cerebral, o que se traduz num acidente vascular cerebral ou num acidente isquémico transitório. 1,2,4,[7][8][9]11 É importante considerar esta doença no diagnóstico diferencial de adultos jovens com a sintomatologia descrita pelas implicações terapêuticas e de prognóstico associadas. Procedeu-se a revascularização indireta esquerda, apesar do acometimento bilateral das ACIs, por ser a estenose mais grave e pela sintomatologia afásica apresentada inicialmente.…”

“…4 É mais frequente na população do leste asiático 2-8 e a idade de inicio tem uma distribuição bimodal com um pico na primeira década de vida e um segundo pico na quarta década de vida. 2,9 O principal sintoma nos adultos é a hemorragia intracraniana que provoca um acidente vascular cerebral hemorrágico. Nas crianças é mais frequente o acidente vascular cerebral isquémico.…”

“…4 Outros sintomas típicos são as cefaleias, tonturas, síncopes, convulsões e declínio cognitivo. 9 A angiografia cerebral é o exame de diagnóstico de eleição. 1,2,4 O tratamento é cirúrgico com revascularização direta ou indireta para prevenir a recorrência de acidente vascular cerebral.…”