Surgical results in pediatric moyamoya disease: Angiographic revascularization and the clinical results

Kim, Dal Soo; Kang, Seok‐Gu; Yoo, Do Sung; Huh, Pil Woo; Cho, Kyoung Suok; Park, Chun Kun

doi:10.1016/j.clineuro.2006.06.004

Cited by 50 publications

(21 citation statements)

References 29 publications

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“…Symptomatic hyperperfusion, transient ischemic injury, postoperative hemorrhage, and seizures can occur after STA-MCA bypass. 6,15 In this study, 13 (7%) of 186 patients who received STA-MCA procedures developed postoperative complications, which included 2 cerebral infarctions (1.1%), 4 hemorrhages (2.2%), 2 seizures (1.1%), and 5 wound infections (2.7%). Five subdural hygromas (2.6%) and 4 seizures (2.1%) occurred in 194 patients after indirect revascularization.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, some of these aneurysms spontaneously resolved after bypass surgery, which has also been reported in other studies. 15 Overall, for MMD associated with intracranial aneurysms, earlier surgical treatment can be performed if feasible, and, for the aneurysms not suitable for clipping or endovascular treatment, regular follow-up is recommended.…”

Section: Discussionmentioning

confidence: 99%

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Clinical features and long-term outcomes of moyamoya disease: a single-center experience with 528 cases in China

Liu

Zhang

Wang

et al. 2015

JNS

108

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OBJECT The aim of this study was to describe the baseline clinical features and long-term outcomes of patients with moyamoya disease (MMD) based on a 25-year period at a single center in China. METHODS Data obtained in 528 consecutive patients with MMD treated at the authors' hospital from 1984 to 2010 were reviewed retrospectively. Events of transient ischemic attack, new infarction, and hemorrhage were included. The Kaplan-Meier risk of stroke was calculated. RESULTS The mean (± SD) patient age was 26 ± 13 years (range 2–67 years), and the female/male ratio was 0.9:1. There were 332 cases of ischemia and 196 hemorrhages. Adults had a higher rate of bleeding than children (50.7% vs 14.0%, respectively; p < 0.001). One hundred twenty-two patients were treated conservatively, and 406 patients underwent revascularization procedures. Of 528 patients, 331 (62.7%) had at least 1 year of follow-up (median 39.5 months) and data from these patients were analyzed. Rebleeding and mortality rates in patients with hemorrhagic MMD (n = 104) were higher than in those with ischemic MMD (n = 227) (26.9% vs 2.2% [p < 0.001] and 4.8% vs 0.4% [p < 0.05], respectively). Twenty-five of 60 (41.7%) conservatively treated patients and 8 of 271 (2.9%) surgically treated patients experienced rebleeding events, a difference that was significant in the Kaplan-Meier curve of rebleeding (p < 0.01). An improvement in perfusion was found in 164 of 224 (73.2%) surgically treated patients 1 month after discharge. However, there was no significant difference in the rate of ischemic events in the surgical and conservative groups (18.8% and 28.3%, respectively; p = 0.09). Among the 104 hemorrhagic cases, rebleeding attacks were observed in 25 patients in the nonsurgical group (n = 60) and 3 patients in the surgical group (n = 44) (41.7% and 6.8%, respectively; OR 9.7 [95% CI 2.7–35.0]; p < 0.01). CONCLUSIONS There was no difference in the sex distribution of Chinese patients with MMD. Patients with hemorrhagic MMD had a much higher rate of rebleeding and poorer prognosis than those with the ischemic type. Surgical revascularization procedures can improve cerebral perfusion and have a positive impact in preventing rebleeding in patients with hemorrhagic MMD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical features and long-term outcomes of moyamoya disease: a single-center experience with 528 cases in China

Liu

Zhang

Wang

et al. 2015

JNS

108

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“…In a similar more recent study, Kim et al 21 used a combined technique to determine if it was more efficacious than an indirect procedure alone. In that study, STA-MCA ϩ EDAMS was completed in 12 sides in 7 children and was compared with EDAS or EDAMS alone.…”

Section: Neurosurg Focus / Volume 24 / February 2008mentioning

confidence: 99%

Moyamoya disease in pediatric patients: outcomes of neurosurgical interventions

Veeravagu¹,

Guzman²,

Patil³

et al. 2008

FOC

116

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✓Neurosurgical interventions for moyamoya disease (MMD) in pediatric patients include direct, indirect, and combined revascularization procedures. Each technique has shown efficacy in the treatment of pediatric MMD; however, no single study has demonstrated the superiority of one technique over another. In this review, the authors explore the various studies focused on the use of these techniques for MMD in the pediatric population. They summarize the results of each study to clearly depict the clinical outcomes achieved at each institution that had utilized direct, indirect, or combined techniques. In certain studies, multiple techniques were used, and the clinical or radiological outcomes were compared accordingly. Direct techniques have been shown to aid a reduction in perioperative strokes and provide immediate revascularization to ischemic areas; however, these procedures are technically challenging, and not all pediatric patients are appropriate candidates. Indirect techniques have also shown efficacy in the pediatric population but may require a longer period for revascularization to occur and perfusion deficits to be reversed. The authors concluded that the clinical efficacy of one technique over another is still unclear, as most studies have had small populations and the same outcome measures have not been applied. Authors who compared direct and indirect techniques noted approximately equal clinical outcomes with differences in radiological findings. Additional, larger studies are needed to determine the advantages and disadvantages of the different techniques for the pediatric age group.

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“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Indirect revascularization surgeries, such as encephaloduroarteriosynangiosis and other variants, are generally accepted as standard for pediatric MMD. 3,4,7,9,12 In adult MMD, however, there is still controversy about the effectiveness of some types of revascularization surgeries because there have been no randomized studies to compare the efficacy of surgical techniques, and several retrospective studies have been conducted with various age ranges, small numbers of patients, short-term follow-up, and no standardization of surgical techniques. [5][6][7]10,12,15,16,18,[20][21][22] We aimed to quantitatively evaluate the long-term outcomes of combined revascularization for patients with adult MMD in our institute in terms of clinical, angiographic, and hemodynamic states.…”

mentioning

confidence: 99%

Long-Term Outcomes After Combined Revascularization Surgery in Adult Moyamoya Disease

Cho

Kim

et al. 2014

Stroke

144

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Background and Purpose-The surgical outcomes of adult moyamoya disease are rarely reported. We aimed to evaluate the long-term outcomes of combined revascularization surgery in patients with adult moyamoya disease. Methods-Combined revascularization surgery consisting of superficial temporal artery-middle cerebral artery anastomosis with encephalodurogaleosynangiosis was performed on 77 hemispheres in 60 patients. Clinical, angiographic, and hemodynamic states were evaluated retrospectively using quantitative methods preoperatively and postoperatively in the short-term (≈6 months) and long-term (≈5 years) periods. The mean clinical follow-up duration was 71.0±10.1 months (range, 60-104 months). Results-Clinical status improved until 6 months after surgery and remained stable thereafter, as assessed by the Karnofsky Performance Scale and modified Rankin Scale. The revascularization area relative to supratentorial area significantly increased in the long-term period compared with that in the short-term period (54.8% versus 44.2%; P<0.001). Cerebral blood flow in the territory of the middle cerebral artery improved in the short-term period compared with that in the preoperative period (68.7 versus 59.1; considering blood flow of the pons as 50; P<0.001) and thereafter became stable (65.5 in the long term; P=0.219). The annual risks of symptomatic hemorrhage and infarction were 0.4% and 0.2%, respectively, in the operated hemispheres. Conclusions-Combined

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Surgical results in pediatric moyamoya disease: Angiographic revascularization and the clinical results

Cited by 50 publications

References 29 publications

Clinical features and long-term outcomes of moyamoya disease: a single-center experience with 528 cases in China

Clinical features and long-term outcomes of moyamoya disease: a single-center experience with 528 cases in China

Moyamoya disease in pediatric patients: outcomes of neurosurgical interventions

Long-Term Outcomes After Combined Revascularization Surgery in Adult Moyamoya Disease

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