Long-term follow-up results in 142 adult patients with moyamoya disease according to management modality

Lee, Sang-Bok; Kim, Dal-Soo; Huh, Pil Woo; Yoo, Do Sung; Lee, Tae-Gyu; Cho, Kyoung-Suok

doi:10.1007/s00701-012-1325-1

Cited by 72 publications

(54 citation statements)

References 40 publications

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“…However, because revascularization using the indirect procedure often results in insufficient revascularization in adults, the direct/combined procedure has been increasingly used. 1,2,6,9,14,15,26,39,44 A limitation of this study was its retrospective nature. Because our surgical procedure also includes several steps of the indirect procedure (inverting dura matter, suturing temporalis muscle to the dura, and the placement of the pericranial flap), the result cannot be simply interpreted as a direct comparison between the direct STA-MCA bypass and indirect procedure alone.…”

Section: Discussionmentioning

confidence: 99%

The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review

Kazumata

Ito

Tokairin

et al. 2014

JNS

156

111

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M oyaMoya disease (MMD) is a progressive stenoocclusive cerebrovascular disease characterized by collateral vascular networks that look like "a puff of smoke" (moyamoya vessels) at the base of the brain. 35,58 Various revascularization procedures have been shown to improve cerebral hemodynamics and decrease the risk of ischemic attack; however, hemodynamic compromises and bleeding-prone vasculopathy lead to postoperative neurological morbidity. In anesthesia management, hypocapnia during surgery induces critical decreases in cerebral blood flow. It is also well known that crying induces hyperventilation and stroke during the perioperative period in children. 45,51 Hemodynamic compromise is also aggravated by blood loss, decreased circulating volume, and low blood pressure. 38,53 Furthermore, recent studies have shown that postoperative hyperperfusion develops frequently after surgery. 11,60 A previous review suggested that direct and combined bypass for MMD provide better collateral circula- Object. Although combined direct and indirect anastomosis in patients with moyamoya disease immediately increases cerebral blood flow, the surgical procedure is more complex. Data pertinent to the postoperative complications associated with combined bypass are relatively scarce compared with those associated with indirect bypass. This study investigated the incidence and characteristics of postoperative stroke in combined bypass and compared them with those determined from a literature review to obtain data from a large population.Methods. A total of 358 revascularization procedures in 236 patients were retrospectively assessed by reviewing clinical charts and radiological data. PubMed was searched for published studies on surgical treatment to determine the incidence of postoperative complications in a larger population.Results. Seventeen instances of postoperative stroke were observed in 16 patients (4.7% per surgery, 95% CI 2.8%-7.5%). Postoperative stroke was more frequent (7.9% per surgery) in adults than in pediatric patients (1.7% per surgery, OR 4.07, 95% CI 1.12-14.7; p < 0.05). Acute progression of stenoocclusive changes were identified in the major cerebral arteries (anterior cerebral artery, n = 3; middle cerebral artery, n = 1; posterior cerebral artery, n = 2). The postoperative stroke rate was comparable with that (5.4%) determined from a literature search that included studies reporting more than 2000 direct/combined procedures. No differences in the stroke rates between the direct/combined and indirect procedures were found. In the literature review, direct/combined bypass was more often associated with excellent revascularization (angiographic opacification greater than two-thirds) than indirect bypass (p < 0.05).Conclusions. This experience of 358 consecutive procedures is one of the largest series for which the postoperative stoke rate for direct/combined bypass performed with a unified strategy has been reported. A systematic review confirmed that the postoperative stroke rate for the direct/combined pro...

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Section: Discussionmentioning

confidence: 99%

The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review

Kazumata

Ito

Tokairin

et al. 2014

JNS

156

111

View full text Add to dashboard Cite

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“…21 Revascularization surgery is effective for improving symptoms and reducing the incidence of subsequent ischemic stroke in patients with ischemic MMD. 23 Whether revascularization surgery is helpful for preventing future intracranial hemorrhaging remains unclear. 17 Some studies have shown that patients who undergo revascularization surgery generally have a lower risk of rebleeding compared with those who undergo conservative treatment, but this difference is not statistically significant.…”

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confidence: 99%

“…17 Some studies have shown that patients who undergo revascularization surgery generally have a lower risk of rebleeding compared with those who undergo conservative treatment, but this difference is not statistically significant. 11,17,23 Patients with MMD are known to exhibit impairments in some cognitive functions, especially executive functions. 13,16,19,29,30,34 For example, Karzmark et al assessed executive function in 30 patients with MMD by examining the total number of correct responses on the Delis-Kaplan Executive Functioning System Design Fluency Test, Letter and Category Fluency Tests, and part B of the Trail Making Test and found that some of these patients had impaired executive functioning.…”

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confidence: 99%

Different aspects of dysexecutive syndrome in patients with moyamoya disease and its clinical subtypes

Fang

Hua

Zhang

et al. 2016

JNS

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obJective Dysexecutive syndrome is common in patients with moyamoya disease (MMD), a chronic cerebrovascular disease that is characterized by stenosis of the bilateral internal carotid arteries and progressive collateral revascularization, and MMD can be classified as ischemic or hemorrhagic according to the disease presentation and history. In this study, the authors aimed to determine which aspects of executive function are impaired in patients with MMD, in addition to the specific dysexecutive functions present among its clinical subtypes and the mechanisms underlying dysexecutive function in these patients. [SART]) to 49 patients with MMD and 47 IQ-, age-, education-, and social status-matched healthy controls. The dysexecutive questionnaire (DEX) was also used to assess participants' subjective feelings about their executive function. A total of 39 of the patients were evaluated by CT perfusion (CTP) before the assessments were performed, and the correlations among the performances of the patients on the above tests with the parameters of cerebral blood volume, cerebral blood flow (CBF), mean transit time (MTT), and time-to-peak (TTP) in the frontal lobes of these patients were also analyzed. results Many aspects of executive function in the patients with MMD were significantly poorer than those in the healthy controls, and the patients performed particularly poorer on the VF test, HSCT, N-back test, and SART. The patients with hemorrhagic MMD exhibited worse executive inhibition, executive processing, and semantic inhibition compared with those with ischemic MMD, but the latter group presented a worse working memory and poorer sustained attention. There were no significant differences in the DEX scores between the patients with MMD and healthy controls. The other findings were as follows: CBF was significantly positively correlated with the number correct on part B of the HSCT (r = 0.481, p = 0.01) and accuracy on the 0-back task of the N-back (r = 0.346, p = 0.031); MTT was significantly positively correlated with accuracy on the 2-back task of the N-back (r = 0.349, p = 0.034) and factor 5 of the DEX (r = 0.359, p = 0.032); and TTP was significantly positively correlated with the number correct on part B of the HSCT (r = 0.402, p = 0.034) and the 1-back reaction time of the N-back (r = 0.356, p = 0.026). coNclusioNs The patients with MMD exhibited impairments in semantic inhibition, executive processing, working memory, and sustained attention, but they were not aware of these deficits. Moreover, differences in dysexecutive function existed between the different subtypes of MMD. Hypoperfusion of the frontal lobe may be related to working memory and semantic inhibition impairments in patients with MMD.

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“…[3101821] The same approach for reduction in risk of recurrent hemorrhage is less well established and debated, although the efficacy, particularly for combined bypass, has been reported. [6815] Management of aneurysms arising from deep collateral perforating vessels, however, poses a specific challenge and reports regarding their management are scarce. As with any aneurysm, definitive and rapid obliteration is desirable to avoid recurrent or incident hemorrhage, but direct surgical obliteration is generally difficult or may risk ischemia through obliteration of the associated collateral vessels.…”

Section: Introductionmentioning

confidence: 99%

Resolution of bilateral moyamoya associated collateral vessel aneurysms: Rationale for endovascular versus surgical intervention

et al. 2014

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Background:Management of aneurysms associated with deep collateral vessels in moyamoya disease is challenging both from an endovascular and a surgical standpoint. Difficulties with access or localization, and compromise of the collateral circulation with subsequent ischemia are the primary concerns, making direct obliteration potentially unfeasible or risky. Alternatively, superficial temporal artery–middle cerebral artery bypass is another potential strategy for resolution of these aneurysms.Case Description:Presented are the findings and management for a patient with moyamoya disease and bilateral deep collateral vessel aneurysms, successfully treated with endovascular obliteration following a right-sided hemorrhage and subsequently with bypass for an unruptured but growing contralateral aneurysm.Conclusions:A rationale and approach to management is outlined, as derived from review of the current literature and the illustrative case with bilateral collateral vessel aneurysms.

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Long-term follow-up results in 142 adult patients with moyamoya disease according to management modality

Cited by 72 publications

References 40 publications

The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review

The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review

Different aspects of dysexecutive syndrome in patients with moyamoya disease and its clinical subtypes

Resolution of bilateral moyamoya associated collateral vessel aneurysms: Rationale for endovascular versus surgical intervention

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