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Miyoshi K, Chida K, Kobayashi M, Kubo Y, Yoshida K, Terasaki K, Ogasawara K. Two-Year Clinical, Cerebral Hemodynamic, and Cognitive Outcomes of Adult Patients Undergoing Medication Alone for Symptomatically Ischemic Moyamoya Disease Without Cerebral Misery Perfusion: A Prospective Cohort Study. Neurosurgery 2020; 84:1233-1241. [PMID: 29850833 DOI: 10.1093/neuros/nyy234] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/03/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In nonsurgical adult moyamoya disease (MMD) patients with ischemic onset and stable hemodynamics, the cerebral hemodynamic and cognitive course remains unclear. OBJECTIVE To clarify, through a prospective cohort study, 2-yr clinical, cerebral hemodynamic, and cognitive outcomes of adult patients receiving medication alone for symptomatically ischemic MMD without cerebral misery perfusion. METHODS Seventy patients without cerebral misery perfusion on the first 15O gas positron emission tomography (PET) were clinically followed up for 2 yr. The second PET was performed at the end of the 2-yr follow-up. Neuropsychological tests were also performed at the study entry and the end of the 2-yr follow-up. RESULTS During the 2-yr follow-up period, 2 patients (3%) developed further cerebral ischemic symptoms and showed new cerebral misery perfusion on PET performed at recurrence. None of the 68 patients without further ischemic symptoms showed cerebral misery perfusion on second PET. All 66 patients who underwent the first and second neuropsychological tests displayed unchanged interval cognition at the 2-yr follow-up. CONCLUSION Among adult patients receiving medication alone for symptomatically ischemic MMD without cerebral misery perfusion, the incidence of recurrent ischemic events was 3% per 2 yr. In patients without recurrent ischemic events, cerebral hemodynamics and cognitive function had not deteriorated by 2 yr after the last event.
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Affiliation(s)
- Kenya Miyoshi
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kohei Chida
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Masakazu Kobayashi
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Yoshitaka Kubo
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kenji Yoshida
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kazunori Terasaki
- Cyclotron Research Center, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, School of Medicine, Iwate Medical University, Morioka, Japan
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Lee WJ, Jeong SK, Han KS, Lee SH, Ryu YJ, Sohn CH, Jung KH. Impact of Endothelial Shear Stress on the Bilateral Progression of Unilateral Moyamoya Disease. Stroke 2020; 51:775-783. [DOI: 10.1161/strokeaha.119.028117] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
In unilateral moyamoya disease, altered endothelial shear stress on the intact-side terminal internal carotid artery might trigger the progression to bilateral disease. We analyzed the endothelial shear stress parameters of the normally appearing terminal internal carotid artery in unilateral moyamoya disease and its association with the progression to bilateral disease.
Methods—
This retrospective cohort study included patients diagnosed with unilateral moyamoya disease by cerebral angiography and followed-up with regular magnetic resonance imaging/magnetic resonance angiography evaluations for >1 year. Endothelial shear stress parameters acquired were mean and maximum signal intensity gradients (SIG) and SIG SD at the vessel boundary in time-of-flight sequences in initial brain magnetic resonance imaging/magnetic resonance angiography. Contralateral disease progression defined as the detection of newly developed vessel steno-occlusion with an magnetic resonance angiography steno-occlusive stage of ≥2, in the previously intact side of the brain on follow-up magnetic resonance imaging/magnetic resonance angiography evaluation.
Results—
Among 146 patients (66 males [45.2%] and 80 females [54.8%]; 76 pediatric [52.1%]), contralateral disease progression was detected in 43 patients (29.5%) after a mean follow-up of 4.3±2.4 years. Multivariate analysis showed that SIG SD was significantly associated with this progression (odds ratio, 13.001 [95% CI, 1.764−95.794],
P
=0.012). In receiver operating characteristic curve analysis, SIG SD predicted the contralateral progression with area under the curve values of 0.803 (95% CI, 0.726−0.880,
P
<0.001). The regression model was reproduced in the external cohort of 31 patients.
Conclusions—
Increased spatial variability of the endothelial shear stress around the normally appearing terminal internal carotid artery, as measured by SIG SD in time-of-flight sequences, may predict the contralateral progression of unilateral moyamoya disease.
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Affiliation(s)
- Woo-Jin Lee
- From the Department of Neurology (W.-J.L., K.-H.J.), Seoul National University Hospital, South Korea
| | - Seul-Ki Jeong
- Jeong Seul-Ki Neurology Clinic, Medi Image, Inc, Seoul, South Korea (S.-K.J.)
| | - Kap-Soo Han
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea (K.-S.H.)
| | - Sang Hyuk Lee
- Nuclear Equipment Qualification & Safety Research Group, Korea Institute of Machinery & Materials, Daejeon, South Korea (S.H.L.)
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea (Y.J.R.)
| | - Chul-Ho Sohn
- Department of Radiology (C.-H.S.), Seoul National University Hospital, South Korea
| | - Keun-Hwa Jung
- From the Department of Neurology (W.-J.L., K.-H.J.), Seoul National University Hospital, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, South Korea (K.-H.J.)
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53
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Wong TH, Shagera QA, Ryoo HG, Ha S, Lee DS. Basal and Acetazolamide Brain Perfusion SPECT in Internal Carotid Artery Stenosis. Nucl Med Mol Imaging 2020; 54:9-27. [PMID: 32206127 PMCID: PMC7062956 DOI: 10.1007/s13139-019-00633-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/19/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022] Open
Abstract
Internal carotid artery (ICA) stenosis including Moyamoya disease needs revascularization when hemodynamic insufficiency is validated. Vascular reserve impairment was the key to find the indication for endarterectomy/bypass surgery in the atherosclerotic ICA stenosis and to determine the indication, treatment effect, and prognosis in Moyamoya diseases. Vascular reserve was quantitatively assessed by 1-day split-dose I-123 IMP basal/acetazolamide SPECT in Japan or by Tc-99m HMPAO SPECT in other countries using qualitative or semi-quantitative method. We summarized the development of 1-day basal/ acetazolamide brain perfusion SPECT for ICA stenosis, both quantitative and qualitative methods, and their methodological issues regarding (1) acquisition protocol; (2) qualitative assessment, either visual or deep learning-based; (3) clinical use for atherosclerotic ICA steno-occlusive diseases and mostly Moyamoya diseases; and (4) their impact on the choice of treatment options. Trials to use CT perfusion or perfusion MRI using contrast materials or arterial spin labeling were briefly discussed in their endeavor to use basal studies alone to replace acetazolamide-challenge SPECT. Theoretical and practical issues imply that basal perfusion evaluation, no matter how much sophisticated, will not disclose vascular reserve. Acetazolamide rarely causes serious adverse reactions but included fatality, and now, we need to monitor patients closely in acetazolamide-challenge studies.
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Affiliation(s)
- Teck Huat Wong
- Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Jongno-Gu, Seoul, 110-744 South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Qaid Ahmed Shagera
- Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Jongno-Gu, Seoul, 110-744 South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Hyun Gee Ryoo
- Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Jongno-Gu, Seoul, 110-744 South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Seunggyun Ha
- Division of Nuclear Medicine Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Jongno-Gu, Seoul, 110-744 South Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, South Korea
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54
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Lee J, Kim SK, Kang HG, Ha IS, Wang KC, Lee JY, Phi JH. High prevalence of systemic hypertension in pediatric patients with moyamoya disease years after surgical treatment. J Neurosurg Pediatr 2020; 25:131-137. [PMID: 31703203 DOI: 10.3171/2019.9.peds1986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although an association between moyamoya disease (MMD) and renovascular hypertension has been acknowledged, the literature on systemic hypertension without renal artery stenosis among patients with MMD is scarce. The authors aimed to evaluate the prevalence and risk factors of hypertension using data from MMD patients who visited an outpatient clinic of a pediatric neurosurgical department in 2016. METHODS The authors evaluated the blood pressure (BP) of pediatric MMD patients at their postsurgical appointment following the American Academy of Pediatrics clinical practice guideline on high BP, in which hypertension was defined as BP measurements higher than the value of age-, sex-, and height-specific 95th percentile of the general population from at least 3 separate visits. Growth of patients was determined using 2017 Korean National Growth Charts for children and adolescents. The cutoff value of the 95th percentile of BP was determined by referring to normative BP tables of Korean children and adolescents. A logistic regression model was used to assess the associations between patients' clinical characteristics and prevalent hypertension. RESULTS In total, 131 surgically treated pediatric MMD patients were included, of whom 38.9% were male and the median age at diagnosis was 8.0 years (range 1.2-15.0 years). The definition of hypertension was met in 38 patients, with a prevalence of 29.0% (95% CI 21.2%-36.8%). A tendency was observed for a higher prevalence of hypertension in male patients (31.4%), in patients with posterior cerebral artery (PCA) involvement (47.8%), and in cases in which infarction was shown on initial MRI (37.3%). Age at diagnosis (adjusted OR [aOR] 0.82, 95% CI 0.70-0.97), PCA involvement (aOR 3.81, 95% CI 1.29-11.23), body mass index (aOR 1.30, 95% CI 1.13-1.51), and years of follow-up since surgery (aOR 0.80, 95% CI 0.68-0.94) were related to systemic hypertension. CONCLUSIONS A high prevalence of hypertension was demonstrated in pediatric MMD patients. Therefore, adequate attention should be paid to reduce BP and prevent subsequent events.
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Affiliation(s)
- Joongyub Lee
- 1Department of Prevention and Management, Inha University Hospital, School of Medicine, Inha University
- 2Incheon Regional Cardiocerebrovascular Disease Center, Incheon
| | | | - Hee Gyung Kang
- 4Department of Pediatrics, Seoul National University Children's Hospital; and
| | - Il-Soo Ha
- 4Department of Pediatrics, Seoul National University Children's Hospital; and
| | | | - Ji Yeoun Lee
- 3Division of Pediatric Neurosurgery and
- 5Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
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Marushima A, Nieminen M, Kremenetskaia I, Gianni-Barrera R, Woitzik J, von Degenfeld G, Banfi A, Vajkoczy P, Hecht N. Balanced single-vector co-delivery of VEGF/PDGF-BB improves functional collateralization in chronic cerebral ischemia. J Cereb Blood Flow Metab 2020; 40:404-419. [PMID: 30621518 PMCID: PMC7370608 DOI: 10.1177/0271678x18818298] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The myoblast-mediated delivery of angiogenic genes represents a cell-based approach for targeted induction of therapeutic collateralization. Here, we tested the superiority of myoblast-mediated co-delivery of vascular endothelial growth factor-A (VEGF) together with platelet-derived growth factor-BB (PDGF-BB) on transpial collateralization of an indirect encephalomyosynangiosis (EMS) in a model of chronic cerebral ischemia. Mouse myoblasts expressing a reporter gene alone (empty vector), VEGF, PDGF-BB or VEGF and PDGF-BB through a single bi-cistronic vector (VIP) were implanted into the temporalis muscle of an EMS following permanent ipsilateral internal carotid artery occlusion in adult, male C57BL/6N mice. Over 84 days, myoblast engraftment and gene product expression, hemodynamic impairment, transpial collateralization, angiogenesis, pericyte recruitment and post-ischemic neuroprotection were assessed. By day 42, animals that received PDGF-BB in combination with VEGF (VIP) showed superior hemodynamic recovery, EMS collateralization and ischemic protection with improved pericyte recruitment around the parenchymal vessels and EMS collaterals. Also, supplementation of PDGF-BB resulted in a striking astrocytic activation with intrinsic VEGF mobilization in the cortex below the EMS. Our findings suggest that EMS surgery together with myoblast-mediated co-delivery of VEGF/PDGF-BB may have the potential to serve as a novel treatment strategy for augmentation of collateral flow in the chronically hypoperfused brain.
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Affiliation(s)
- Aiki Marushima
- Department of Neurosurgery and Center for Stroke research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Melina Nieminen
- Department of Neurosurgery and Center for Stroke research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Irina Kremenetskaia
- Department of Neurosurgery and Center for Stroke research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Roberto Gianni-Barrera
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Johannes Woitzik
- Department of Neurosurgery and Center for Stroke research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Andrea Banfi
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Peter Vajkoczy
- Department of Neurosurgery and Center for Stroke research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nils Hecht
- Department of Neurosurgery and Center for Stroke research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
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Liu Z, Han C, Wang H, Zhang Q, Li S, Bao X, Zhang Z, Duan L. Clinical characteristics and leptomeningeal collateral status in pediatric and adult patients with ischemic moyamoya disease. CNS Neurosci Ther 2020; 26:14-20. [PMID: 31875482 PMCID: PMC6930821 DOI: 10.1111/cns.13130] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 11/28/2022] Open
Abstract
AIM Previous studies have found significant differences in clinical characteristics between pediatric and adult moyamoya disease (MMD) patients, but few studies have focused on the factors underlying these differences. We aimed to investigate the differences in leptomeningeal collateral (LMC) status between pediatric and adult MMD patients and to analyze the effects of LMCs on clinical characteristics and therapeutic prognosis. METHODS We retrospectively analyzed 214 MMD patients from January 2014 to January 2016. Clinical characteristics and LMC status were compared between the pediatric and adult patients. LMC status was graded as good or poor depending on the retrograde flow from the posterior cerebral artery (PCA) on digital subtraction angiography (DSA). RESULTS A total of 83 pediatric and 131 adult (1:1.6) MMD patients were analyzed. Pediatric patients were more likely to experience a transient ischemic attack (81%), whereas adult patients were more likely to experience infarction (51%). Regarding the different MMD stages (the early, medium, and advanced stages corresponded to Suzuki stages 1-2, 3-4, and 5-6, respectively), the prevalence of good LMC status was higher for pediatric patients than for adult patients in the early stage (P = 0.047) and the medium stage (P = 0.001), but there were no differences between these patient groups in the advanced stage (P = 0.547). Worse postoperative angiographic outcomes (P = 0.017) were found in adult patients than in pediatric patients in the medium stage. Poor LMC status had strong correlations with infarction (P < 0.001 and P = 0.017) and poor postoperative outcomes (P = 0.003 and P = 0.043) in both pediatric and adult patients. CONCLUSIONS Pediatric MMD patients have greater patency and a greater ability to establish good LMC status than adult patients, and poor LMC status has a strong correlation with severe clinical symptoms and poor postoperative outcomes. LMC status may be an important factor in the differences in clinical characteristics and prognosis between pediatric and adult MMD patients.
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Affiliation(s)
- Zhi‐Wen Liu
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General HospitalThe 307th Hospital of the Chinese People's Liberation ArmyAcademy of Military Medical ScienceBeijingChina
| | - Cong Han
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General HospitalThe 307th Hospital of the Chinese People's Liberation ArmyAcademy of Military Medical ScienceBeijingChina
| | - Hui Wang
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General HospitalThe 307th Hospital of the Chinese People's Liberation ArmyAcademy of Military Medical ScienceBeijingChina
| | - Qian Zhang
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General HospitalThe 307th Hospital of the Chinese People's Liberation ArmyAcademy of Military Medical ScienceBeijingChina
| | - Si‐Jie Li
- Departments of Neurology and Neurosurgery, Xuanwu Hospital, Center of Stroke, Beijing Institute for Brain DisordersCapital Medical UniversityBeijingChina
| | - Xiang‐yang Bao
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General HospitalThe 307th Hospital of the Chinese People's Liberation ArmyAcademy of Military Medical ScienceBeijingChina
| | - Zheng‐Shan Zhang
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General HospitalThe 307th Hospital of the Chinese People's Liberation ArmyAcademy of Military Medical ScienceBeijingChina
| | - Lian Duan
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General HospitalThe 307th Hospital of the Chinese People's Liberation ArmyAcademy of Military Medical ScienceBeijingChina
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Choi JW, Chong S, Phi JH, Lee JY, Kim HS, Chae JH, Lee J, Kim SK. Postoperative Symptomatic Cerebral Infarction in Pediatric Moyamoya Disease: Risk Factors and Clinical Outcome. World Neurosurg 2019; 136:e158-e164. [PMID: 31870818 DOI: 10.1016/j.wneu.2019.12.072] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Indirect bypass surgery is used to improve the hemodynamic status of pediatric patients with moyamoya disease (MMD). Symptomatic cerebral infarction during the early postoperative period may be the most frustrating complication. This study was conducted to investigate the factors associated with early postoperative symptomatic cerebral infarction. METHODS Between January 2000 and February 2014, we performed 1241 indirect bypass surgeries in 659 pediatric MMD patients. Symptomatic infarction during the early postoperative period was diagnosed in 63 operations in 61 patients. RESULTS The overall incidence of symptomatic cerebral infarction after indirect bypass surgery was 5.1%. The median age of the patients with postoperative infarction was 6 years (mean, 6.4 years; range, 1-15 years). The performance of 2 craniotomies in single operation was associated with a higher rate of cerebral infarction. Moreover, the incidence was higher in young patients (age <6 years) compared with older patients. In a matched analysis, an immediate postoperative hemoglobin level >13 g/dL was associated with decreased risk of infarction (odds ratio, 0.144; P = 0.003). Mutation of the methylenetetrahydrofolate reductase (MTHFR) gene occurred in a relatively high proportion of our infarction cohort. CONCLUSIONS Postoperative symptomatic infarctions can occur despite a unified surgical method and formulaic perioperative management protocol. Patient-centered factors, such as young age, genetic background of MTHFR, and certain medical conditions, including hyperthyroidism, renovascular hypertension, and hemolytic uremic syndrome, as well as management-related factors, including 2 craniotomies and low immediate postoperative hemoglobin level, could be risk factors for early postoperative symptomatic cerebral infarction.
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Affiliation(s)
- Jung Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sangjoon Chong
- Department of Neurosurgery, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee-Soo Kim
- Division of Pediatric Anesthesiology and Pain Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Hee Chae
- Division of Pediatric Neurology, Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joongyub Lee
- Division of Clinical Epidemiology, Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Ravindran K, Wellons JC, Dewan MC. Surgical outcomes for pediatric moyamoya: a systematic review and meta-analysis. J Neurosurg Pediatr 2019; 24:663-672. [PMID: 31518973 DOI: 10.3171/2019.6.peds19241] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The optimal revascularization for pediatric moyamoya for reducing the incidence of future stroke events remains to be determined. METHODS The authors conducted a search of PubMed, MEDLINE, Embase, and Web of Science electronic databases from inception until January 2019. The primary endpoint was the presence of a future ischemic stroke event. Secondary endpoints were angiographic outcomes as measured by postoperative Matsushima grade and clinical symptom persistence. Patients who underwent either direct or combined direct/indirect revascularization were classified into the direct cohort. Data from each study on presence of postoperative stroke events were used to generate standardized mean differences and 95% confidence intervals, which were combined using inverse variance-weighted averages of standardized mean differences in a random effects model. RESULTS Twenty-nine studies met the inclusion criteria for analysis, comprising 2258 patients (1011 males, mean age 8.3 ± 1.8 years) who were followed up clinically for an average of 71.4 ± 51.3 months. One hundred fifty-four patients underwent direct bypass alone, 680 patients underwent either direct or combined direct/indirect revascularization procedures, while 1424 patients underwent indirect bypass alone. The frequencies of future stroke events in patients undergoing direct bypass alone, combined bypass, or indirect bypass alone were 1 per 190.3 patient-years, 1 per 108.9 patient-years, and 1 per 61.1 patient-years, respectively, in each cohort. The estimated stroke rates were 9.0% with indirect revascularization, 4.5% with direct revascularization alone, and 6.0% with combined revascularization. A forest plot did not reveal any significant differences in the incidence of future stroke events or angiographic outcomes following direct-only, combined, or indirect-only revascularization. CONCLUSIONS Direct, indirect, and combined indirect/direct bypass techniques are all effective revascularization options for pediatric moyamoya disease. A relative paucity of granular studies-and inherent surgical selection bias-limits direct comparison between interventions. Suitably designed prospective cohort studies may be useful in identifying patients likely to receive benefit from specific procedures.
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Affiliation(s)
| | - John C Wellons
- 2Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael C Dewan
- 2Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Boulouis G, Blauwblomme T, Hak JF, Benichi S, Kirton A, Meyer P, Chevignard M, Tournier-Lasserve E, Mackay MT, Chabrier S, Cordonnier C, Kossorotoff M, Naggara O. Nontraumatic Pediatric Intracerebral Hemorrhage. Stroke 2019; 50:3654-3661. [DOI: 10.1161/strokeaha.119.025783] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Gregoire Boulouis
- From the Pediatric Radiology Department, Necker Enfants Malades (NEM), INSERM UMR1266, Sainte-Anne (G.B., J.F.H., O.N.)
| | - Thomas Blauwblomme
- Pediatric Neurosurgery Department, Institut Imagine, INSERM UMR 1163, NEM (T.B., S.B.)
| | - Jean François Hak
- From the Pediatric Radiology Department, Necker Enfants Malades (NEM), INSERM UMR1266, Sainte-Anne (G.B., J.F.H., O.N.)
- Neuroimaging Department, CHRU La Timone, Marseille, France (J.F.H.)
| | - Sandro Benichi
- Pediatric Neurosurgery Department, Institut Imagine, INSERM UMR 1163, NEM (T.B., S.B.)
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada (A.K.)
- Pediatric Neuro ICU (A.K.)
| | | | - Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint-Maurice Hospitals (M.C.)
| | - Elisabeth Tournier-Lasserve
- Genetics of Neurovascular disorders, AP-HP, Hôpital Lariboisière and Université de Paris, NeuroDiderot, Inserm, F-75010 (E.T.-L.)
| | - Mark T. Mackay
- Neurology Department, Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute, and Department of Paediatrics, University of Melbourne, Australia (M.T.M.)
| | - Stéphane Chabrier
- CHU Saint-Étienne, French Center for Pediatic Stroke, F-42055 Saint-Étienne, France (S.C.)
| | - Charlotte Cordonnier
- Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Neurology Department, France (C.C.)
| | - Manoëlle Kossorotoff
- Department of Pediatric Neurology, French Center for Pediatic Stroke, NEM (M.K.)
| | - Olivier Naggara
- From the Pediatric Radiology Department, Necker Enfants Malades (NEM), INSERM UMR1266, Sainte-Anne (G.B., J.F.H., O.N.)
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Yanagihara W, Chida K, Kobayashi M, Kubo Y, Yoshida K, Terasaki K, Ogasawara K. Impact of cerebral blood flow changes due to arterial bypass surgery on cognitive function in adult patients with symptomatic ischemic moyamoya disease. J Neurosurg 2019; 131:1716-1724. [PMID: 30554180 DOI: 10.3171/2018.7.jns18149] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/31/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Some adult patients with moyamoya disease (MMD) undergoing revascularization surgery show an improvement or decline in cognition postoperatively. Revascularization surgery for ischemic MMD augments cerebral blood flow (CBF) and improves cerebral oxygen metabolism. However, cerebral hyperperfusion, which is a short-term, major increase in ipsilateral CBF that is much greater than the metabolic needs of the brain, sometimes occurs as a complication. Cerebral hyperperfusion produces widespread, minimal injury to the ipsilateral white matter and cortical regions. The aim of the present prospective study was to determine how changes in CBF due to arterial bypass surgery affect cognitive function in adult patients with symptomatic ischemic MMD and misery perfusion. METHODS Thirty-two patients with cerebral misery perfusion, as determined on the basis of 15O gas positron emission tomography, underwent single superficial temporal artery-middle cerebral artery (M4 in the precentral region) anastomosis. Brain perfusion single-photon emission computed tomography (SPECT) studies were performed preoperatively, on the 1st postoperative day, and 2 months after surgery. Neuropsychological tests were also performed preoperatively and 2 months after surgery. RESULTS Postoperative neuropsychological assessments demonstrated cognitive improvement in 10 cases (31%), no change in 8 cases (25%), and decline in 14 cases (44%). Based on brain perfusion SPECT and symptoms, 10 patients were considered to have cerebral hyperperfusion syndrome, and all of these patients exhibited a postoperative decline in cognition. Relative precentral CBF on the 1st postoperative day was significantly greater in patients with postoperative cognitive decline (167.3% ± 15.3%) than in those with improved (105.3% ± 18.2%; p < 0.0001) or unchanged (131.4% ± 32.1%; p = 0.0029) cognition. The difference between relative precentral CBF 2 months after surgery and that before surgery was significantly greater in patients with postoperative cognitive improvement (17.2% ± 3.8%) than in those with no postoperative change (10.1% ± 2.4%; p = 0.0003) or with postoperative decline (11.5% ± 3.2%; p = 0.0009) in cognition. CONCLUSIONS Cerebral hyperperfusion in the acute stage after arterial bypass surgery impairs cognitive function. An increase in CBF in the chronic stage without acute-stage cerebral hyperperfusion improves cognitive function in adult patients with symptomatic ischemic MMD and misery perfusion.
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Affiliation(s)
- Wataru Yanagihara
- 1Department of Neurosurgery and
- 2Cyclotron Research Center, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kohei Chida
- 1Department of Neurosurgery and
- 2Cyclotron Research Center, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Masakazu Kobayashi
- 1Department of Neurosurgery and
- 2Cyclotron Research Center, School of Medicine, Iwate Medical University, Morioka, Japan
| | | | | | - Kazunori Terasaki
- 2Cyclotron Research Center, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kuniaki Ogasawara
- 1Department of Neurosurgery and
- 2Cyclotron Research Center, School of Medicine, Iwate Medical University, Morioka, Japan
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61
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Yu J, Zhang J, Li J, Zhang J, Chen J. Cerebral Hyperperfusion Syndrome After Revascularization Surgery in Patients with Moyamoya Disease: Systematic Review and Meta-Analysis. World Neurosurg 2019; 135:357-366.e4. [PMID: 31759149 DOI: 10.1016/j.wneu.2019.11.065] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cerebral hyperperfusion syndrome (CHS) after bypass surgery is known as a complication of moyamoya disease (MMD). However, the incidence of CHS has not been accurately reported, and there is no consensus on related risk factors. OBJECTIVE To evaluate the incidence and characteristics of CHS in patients with MMD after revascularization surgery via meta-analysis. METHODS Relevant cohort studies were retrieved through a literature search of PubMed, Embase, and Ovid until December 1, 2018. Eligible studies were identified per search criteria. A systematic review and meta-analysis were used to assess the CHS total incidence, incidence in pediatric patients with MMD and adult patients with MMD, incidence for direct and combined bypass surgery, progress rate, and proportion of each symptom (including transient neurologic deficits [TNDs], hemorrhage, and seizure). RESULTS A total of 27 cohort studies with 2225 patients were included in this meta-analysis. The weighted proportions per random-effects model were 16.5% (range, 11.3%-22.3%) for CHS total incidence, 3.8% (range, 0.3%-9.6%) for pediatric patients with MMD, 19.9% (range, 11.7%-29.4%) for adult patients with MMD, 15.4% (range, 5.4%-28.8%) for direct bypass surgery, and 15.2% (range, 8.4%-23.2%) for combined bypass surgery. Progress rate was 39.5% (range, 28.7%-50.8%). The most common CHS-related symptom was TNDs (70.2%; range, 56.3%-82.7%), followed by hemorrhage (15.0%; range, 5.5%-26.9%) and seizure (5.3%; range, 0.6%-12.9%). CONCLUSIONS CHS is a common complication after revascularization surgery in MMD. It is more frequently seen in adult patients. The most common CHS-related symptom was TNDs, followed by hemorrhage and seizure.
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Affiliation(s)
- Jin Yu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jibo Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jieli Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jianjian Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Zhang Q, Ge P, Ma Y, Zhang D, Wang R, Zhang Y, Wang S, Cao Y, Zhao M, Zhao J. Clinical Features and Surgical Outcomes of Patients With Moyamoya Disease and the Homozygous RNF213 p.R4810K Variant. J Child Neurol 2019; 34:793-800. [PMID: 31290353 DOI: 10.1177/0883073819858264] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The ring-finger protein 213 (RNF213) gene is a major susceptibility gene for moyamoya disease. The homozygote of the p.R4810K variant on RNF213 exhibits an early onset age and severe form of moyamoya disease. We report 4 unrelated pediatric moyamoya disease cases with the homozygous p.R4810K variant and the long-term surgical outcomes. Published reports on surgical outcome of moyamoya disease case with the homozygous p.R4810K variant were reviewed. Cerebral angiography revealed classic angiographic findings of moyamoya disease in 7 hemispheres of the 4 children. All patients underwent successful indirect revascularization. Abundant collateral blood flow from the external carotid arteries to the internal carotid arteries was observed in all bypass procedures by angiography. Improvements in symptoms and cerebral blood volume were observed in all patients at long-term follow-up. This report is the first case series in the literature on the surgical management of these patients. These cases highlight the effectiveness of indirect revascularization for moyamoya disease patients with the homozygous p.R4810K variant. Early diagnosis and treatment are crucial to avoid irreversible neurologic deficits in these patients.
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Affiliation(s)
- Qian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Peicong Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yonggang Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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63
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Shear A, Nishihiro S, Hishikawa T, Hiramatsu M, Sugiu K, Yasuhara T, Date I. Cerebral circulation improves with indirect bypass surgery combined with gene therapy. Brain Circ 2019; 5:119-123. [PMID: 31620658 PMCID: PMC6785951 DOI: 10.4103/bc.bc_33_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023] Open
Abstract
Angiogenesis involves new blood vessels sprouting from preexisting blood vessels. This process may serve to improve brain circulation. Moyamoya disease (MMD) is a cerebrovascular disorder causing intracranial stenosis which significantly reduces the blood supply to the brain. Mainly stroke is the first symptom of the disorder, so treatments that reduce the risk of stroke are used for patients with MMD. To prevent stroke for those with chronic cerebral hypoperfusion, more blood needs to flow to the brain, which was thought to be achieved by enhancing angiogenesis. Indirect bypass surgery, such as encephalo-myo-synangiosis (EMS), is used for revascularization. However, EMS alone sometimes cannot provide enough circulation to avoid ischemic strokes. The current study examined if EMS combined with high-mobility group box-1 (HMGB1) and vascular endothelial growth factor (VEGF) enhanced angiogenesis and increased cerebral circulation. The results indicated that HMGB1 administered with EMS increased angiogenesis through a VEGF-dependent mechanism. In addition, exercising and stem cell transplantation possess possible means to increase angiogenesis. Overall, EMS with gene therapy, maintaining fitness, and stem cell utilization may prevent or help one recover from stroke by enhancing brain angiogenesis. Thus, these treatments may be applicable for patients with MMD. This paper is a review article. Referred literature in this paper has been listed in the references section. The datasets supporting the conclusions of this article are available online by searching various databases, including PubMed.
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Affiliation(s)
- Alex Shear
- Department of Neurosurgery and Brain Repair, College of Medicine, University of South Florida Morsani, Tampa, FL, USA
| | - Shingo Nishihiro
- Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tomohito Hishikawa
- Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Masafumi Hiramatsu
- Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kenji Sugiu
- Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takao Yasuhara
- Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Isao Date
- Department of Neurological Surgery, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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64
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Ha EJ, Kim KH, Wang KC, Phi JH, Lee JY, Choi JW, Cho BK, Yang J, Byun YH, Kim SK. Long-Term Outcomes of Indirect Bypass for 629 Children With Moyamoya Disease: Longitudinal and Cross-Sectional Analysis. Stroke 2019; 50:3177-3183. [PMID: 31551037 DOI: 10.1161/strokeaha.119.025609] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- In pediatric moyamoya disease, there are few reports on the efficacy of surgical intervention for stroke prevention. We evaluated the long-term outcomes of indirect bypass surgery on a relatively large number of children with moyamoya disease in a single center. Methods- From August 1988 to December 2012, 772 children underwent indirect bypass surgery. This study included 629 patients who were followed up for >5 years, excluding patients with moyamoya syndrome. The mean clinical follow-up duration was 12 years (range, 5-29 years). Cross-sectional analysis was performed based on either Karnofsky Performance Scale or Lansky Play Performance Scale to evaluate overall clinical outcomes and factors associated with unfavorable outcomes. To analyze the longitudinal effect of surgery, the annual risk of symptomatic infarction or hemorrhage on the operated hemisphere after indirect bypass surgery was calculated with a person-year method, and the event-free survival rate was evaluated using the Kaplan-Meier method. Results- The overall clinical outcome was favorable in 95% of the patients. The annual risks of symptomatic infarction and hemorrhage on the operated hemispheres were 0.08% and 0.04%, respectively. Furthermore, the 10-year event-free survival rates for symptomatic infarction and hemorrhage were 99.2% and 99.8%. Conclusions- Indirect bypass surgery could provide satisfactory long-term improvement in overall clinical outcome and prevention of recurrent stroke in children with moyamoya disease.
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Affiliation(s)
- Eun Jin Ha
- From the Department of Neurosurgery, Seoul National University Hospital (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.), Seoul National University College of Medicine, Republic of Korea.,Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Republic of Korea (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.).,Critical Care Center, Seoul National University Hospital, Republic of Korea (E.J.H.)
| | - Kyung Hyun Kim
- From the Department of Neurosurgery, Seoul National University Hospital (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.), Seoul National University College of Medicine, Republic of Korea.,Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Republic of Korea (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.)
| | - Kyu-Chang Wang
- From the Department of Neurosurgery, Seoul National University Hospital (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.), Seoul National University College of Medicine, Republic of Korea.,Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Republic of Korea (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.)
| | - Ji Hoon Phi
- From the Department of Neurosurgery, Seoul National University Hospital (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.), Seoul National University College of Medicine, Republic of Korea.,Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Republic of Korea (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.)
| | - Ji Yeoun Lee
- From the Department of Neurosurgery, Seoul National University Hospital (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.), Seoul National University College of Medicine, Republic of Korea.,Department of Anatomy (J.Y.L.), Seoul National University College of Medicine, Republic of Korea.,Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Republic of Korea (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.)
| | - Jung Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.W.C.)
| | - Byung-Kyu Cho
- Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam, Republic of Korea (B.-K.C.)
| | - Jeyul Yang
- From the Department of Neurosurgery, Seoul National University Hospital (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.), Seoul National University College of Medicine, Republic of Korea.,Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Republic of Korea (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.)
| | - Yoon Hwan Byun
- From the Department of Neurosurgery, Seoul National University Hospital (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.), Seoul National University College of Medicine, Republic of Korea.,Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Republic of Korea (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.)
| | - Seung-Ki Kim
- From the Department of Neurosurgery, Seoul National University Hospital (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.), Seoul National University College of Medicine, Republic of Korea.,Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Republic of Korea (E.J.H., K.H.K., K.-C.W., J.H.P., J.Y.L., J.Y., Y.H.B., S.-K.K.)
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65
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DeDios-Stern S, Ventura LM. A pediatric case of NF1 and moyamoya syndrome: Neuropsychological evaluation pre- and post-EDAS. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:283-296. [PMID: 31523973 DOI: 10.1080/21622965.2019.1665292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Studies have shown that a subset of patients with neurofibromatosis type 1 (NF1) experience associated vascular conditions, with moyamoya syndrome one of the most common comorbidities. While NF1 and moyamoya syndrome are each associated with neurocognitive deficits, no neuropsychological data has been presented for an individual with comorbid NF1 and moyamoya syndrome, particularly pre- and post-re-vascularization surgery. The present case describes the neuropsychological profile of a bilingual Latina girl with NF1 and moyamoya syndrome, who was assessed pre- (age 5 years, 9 months) and post-EDAS (age 6 years, 1 month). Each evaluation included a clinical interview and comprehensive battery of neuropsychological tests. Results of pre-EDAS evaluation documented significant deficits in sustained attention, daily executive functioning, and academic abilities, and she met criteria for ADHD-combined type. Results of post-EDAS evaluation revealed generally stable abilities with relative improvements in social, emotional, and behavioral functioning, but relative decline in visuospatial skills, visual spatial learning/memory, and aspects of executive functioning. Math abilities also remained consistently poor and she was diagnosed with a specific learning disability (mathematics). This case study adds to the current literature by being among the first to present pre- and post-surgical neuropsychological data for a child with NF1 and moyamoya syndrome. Findings are discussed in the context of previous literature, the importance of individual socio-cultural considerations in the case (i.e., language, education, culture), and recommendations for future research.
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Affiliation(s)
- Samantha DeDios-Stern
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Lea M Ventura
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Pediatrics, University of Illinois College of Medicine, Chicago, IL, USA
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66
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Sato Y, Kazumata K, Nakatani E, Houkin K, Kanatani Y. Characteristics of Moyamoya Disease Based on National Registry Data in Japan. Stroke 2019; 50:1973-1980. [DOI: 10.1161/strokeaha.119.024689] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background and Purpose—
A public registration system for intractable diseases was started in Japan in 1972 to investigate the etiology and pathogenesis of intractable diseases while reducing out-of-pocket medical expenses on patients. The goal of this study was to investigate the epidemiology and clinical characteristics of Moyamoya disease using data from applications submitted to this system between 2004 and 2008.
Methods—
In addition to demographic factors such as onset age and family history, we evaluated clinical presentation type, imaging findings, clinical symptoms, and functioning in activities of daily living (ADL).
Results—
Of 3859 cases for which applications were submitted, 2545 were confirmed to meet the diagnostic criteria after data cleansing. Onset age showed a bimodal distribution, and Moyamoya disease had a higher incidence in women than in men. The presence of occlusion and infarction in the proximal region of the anterior cerebral artery was more frequent in pediatric cases than adult cases. Our findings also indicated that 23% of patients required assistance with ADL. Cerebral infarction (odds ratio [OR], 12.5; 95% CI, 3.55–44.66), seizure (OR, 7.44; 95% CI, 1.29–42.96), and sensory disorders (OR, 5.23; 95% CI, 1.15–23.75) were identified as significant predictors of impaired ADL in pediatric cases 3 years after the initial application. Moderate ADL function (OR, 11.59; 95% CI, 5.29–25.39) and intellectual disabilities (OR, 4.38; 95% CI, 1.58–12.17) at the time of the application were identified as significant prognostic factors in adults.
Conclusions—
The results of this study indicated that characteristics of Moyamoya disease such as onset type, symptoms, and imaging abnormalities differ with onset age. Prognostic analyses suggested that pediatric cases with good ADL but with infarct type onset, seizure, or sensory disorders might have a subsequent decline in ADL.
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Affiliation(s)
- Yoko Sato
- From the Division of Biomedical Engineering, National Defense Medical Research Institute, National Defense Medical College, Saitama, Japan (Y.S.)
| | - Ken Kazumata
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan (K.K., K.H.)
| | - Eiji Nakatani
- Division of Medical Statistics, Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation at Kobe, Hyogo, Japan (E.N.)
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan (K.K., K.H.)
| | - Yasuhiro Kanatani
- Division of Statistical Analysis, Research Support Center, Shizuoka General Hospital, Japan (E.N.)
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Hervé D, Ibos-Augé N, Calvière L, Rogan C, Labeyrie MA, Guichard JP, Godin O, Kossorotoff M, Habert MO, Lasserve ET, Chevret S, Chabriat H. Predictors of clinical or cerebral lesion progression in adult moyamoya angiopathy. Neurology 2019; 93:e388-e397. [PMID: 31239360 PMCID: PMC6669931 DOI: 10.1212/wnl.0000000000007819] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/11/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To identify independent predictors of clinical or cerebral lesion progression in a large sample of adult patients with moyamoya angiopathy (MMA) prior to decisions regarding revascularization surgery. METHODS Ninety participants (median age, 37.5 years) were assessed at baseline and followed for a median time of 42.8 months. Incident ischemic and hemorrhagic strokes, death, as well as any incident ischemic and hemorrhagic lesions on MRI were recorded. Multiple demographic, clinical, and cerebral imaging measures at baseline were considered as potential predictors of clinical or cerebral tissue change at follow-up. Data were analyzed based on the Andersen-Gill counting process model, followed by internal validation of the prediction model. RESULTS Among multiple potential predictive measures considered in the analysis, Asian origin, a history of TIAs, and a reduction in hemodynamic reserve, as detected by imaging, were found to be significantly associated with an increased risk of combined clinical and imaging events. While the model estimated the risk of clinical or cerebral lesion progression to be approximately 0.5% per year when none of these factors was present, this risk exceeded 20% per year when all factors were present. CONCLUSION A simple combination of demographic, clinical, and cerebral perfusion imaging measures may aid in predicting the risk of incident stroke and cerebral lesion progression in adult patients with MMA. These results may help to improve therapeutic decisions and aid in the design of future trials in adults with this rare condition.
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Affiliation(s)
- Dominique Hervé
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France.
| | - Nathanaelle Ibos-Augé
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Lionel Calvière
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Christina Rogan
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Marc Antoine Labeyrie
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Jean Pierre Guichard
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Ophélia Godin
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Manoelle Kossorotoff
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Marie Odile Habert
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Elisabeth Tournier Lasserve
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Sylvie Chevret
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France
| | - Hugues Chabriat
- From the Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), Department of Neurology and DHU NeuroVasc (D.H., N.I.-A., C.R., O.G., H.C.), Department of Neuroradiology (M.A.L., J.P.G.), and Laboratoire de Génétique Moléculaire (E.T.L.), Hopital Lariboisiére, Department of Nuclear Medicine, Hopital Salpêtrière (M.O.H.), and Service de Biostatistique et Information Médicale, Hôpital Saint Louis (S.C.), Assistance Publique des Hôpitaux de Paris; INSERM U 1161 (D.H., E.T.L., H.C.) and UMR 1153 INSERM (S.C.), Université Paris 7 Diderot (E.T.L., H.C.), Sorbonne Paris Cité; Unité Neurovasculaire (L.C.), Hôpital Pierre-Paul-Riquet, Toulouse; Centre National de Référence de l'AVC de l'Enfant, Hôpital Universitaire Necker-Enfants Malades (M.K.), AP-HP; Sorbonne Paris Cité, Paris; and ECSTRA Team (Épidémiologie Clinique et Statistiques pour la Recherche en Santé) (S.C.), Paris, France.
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Byun YH, Phi JH, Lee JY, Ha EJ, Kim KH, Yang J, Kim HS, Ryu SK, Choi JW, Cho BK, Kim SK. Preservation of the Arachnoid Membrane During Encephaloduroarteriosynangiosis Reduces Postoperative Complications without Undermining the Surgical Outcome in Pediatric Moyamoya Disease. World Neurosurg 2019; 130:e406-e416. [PMID: 31233923 DOI: 10.1016/j.wneu.2019.06.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Encephaloduroarteriosynangiosis (EDAS) is a commonly used indirect revascularization operation method to treat pediatric patients with Moyamoya disease (MMD). Arachnoid dissection frequently has been performed during the EDAS operation to promote better revascularization. However, no studies have yet proven its surgical benefits. In this study, we investigated the impact of arachnoid preservation on the surgical outcome and postoperative complication by comparing pediatric patients with MMD who had the arachnoid membrane preserved during EDAS operation with those who had it dissected. METHODS This was a retrospective cohort study based on a single surgeon's experience at a single institution. A total of 206 pediatric patients with MMD who underwent EDAS operation at Seoul National University Children's Hospital were recruited for the study. We compared the surgical outcome and the postoperation complication rate of these 2 groups. Furthermore, risk factors for postoperative complication were analyzed. RESULTS The overall clinical outcome (P = 0.342) and the extent of revascularization of middle cerebral artery territories (P = 0.736) were not different between the arachnoid dissection group and the arachnoid preservation group. However, the postoperative infarction/hemorrhage rate was significantly greater in the arachnoid dissection group (P = 0.005). Arachnoid dissection (P = 0.011) and young age (<3 years old, P = 0.012) were significantly associated with increased risk of postoperative complications. CONCLUSIONS Arachnoid preservation may help to reduce postoperative complications without decreasing the surgical outcome of EDAS. Furthermore, factors such as the patient's age should be taken into account when treating pediatric patients with MMD.
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Affiliation(s)
- Yoon Hwan Byun
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Phi
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Ji Yeoun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea; Department of Anatomy, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Jin Ha
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Critical Care Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Hyun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jeyul Yang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seul Ki Ryu
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jung Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.
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Wang QN, Bao XY, Zhang Y, Zhang Q, Li DS, Duan L. Encephaloduroarteriosynangiosis for hemorrhagic moyamoya disease: long-term outcome of a consecutive series of 95 adult patients from a single center. J Neurosurg 2019; 130:1898-1905. [PMID: 29999465 DOI: 10.3171/2017.12.jns172246] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 12/11/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to investigate long-term outcomes after encephaloduroarteriosynangiosis (EDAS) for the treatment of hemorrhagic moyamoya disease (MMD) and identify the risk factors for recurrent hemorrhages. METHODS The authors retrospectively reviewed 95 patients with hemorrhagic MMD who were treated with EDAS at 307th Hospital PLA. Clinical features, angiographic findings, and clinical outcomes were investigated. Rebleeding incidences were compared between anterior or posterior hemorrhagic sites. Kaplan-Meier survival analysis and Cox proportional hazards regression models were used to estimate rebleeding risks after EDAS. RESULTS The average age at symptom onset was 37.1 years (range 20-54 years) for adult patients. The ratio of female to male patients was 1.16:1. In 61 of 95 hemorrhagic hemispheres (64.2%), the anterior choroidal artery (AChA) or posterior communicating artery (PCoA) was extremely dilated, with extensive branches beyond the choroidal fissure, which only occurred in 28 of 86 nonhemorrhagic hemispheres (32.6%). Fifty-seven incidences were classified as anterior hemorrhages and 38 as posterior. Sixteen of 95 patients (16.8%) suffered cerebral rebleeding after a median follow-up duration of 8.5 years. The annual rebleeding rate was 2.2% per person per year. The incidence rate was higher for the posterior group than for the anterior group, but this difference was not statistically significant (p > 0.05). Cox regression analysis revealed that the age of symptom onset (OR 1.075, 95% CI 1.008-1.147, p = 0.028) was a predictor of rebleeding strokes. CONCLUSIONS Through long-term follow up, EDAS proved beneficial for patients with hemorrhagic MMD. Dilation of the AChA-PCoA is associated with the initial hemorrhage of MMD, and rebleeding is age-related. Patients with hemorrhagic MMD should undergo follow-up over the course of their lives, even when neurological status is excellent.
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Nishihiro S, Hishikawa T, Hiramatsu M, Kidani N, Takahashi Y, Murai S, Sugiu K, Higaki Y, Yasuhara T, Borlongan CV, Date I. High-Mobility Group Box-1-Induced Angiogenesis After Indirect Bypass Surgery in a Chronic Cerebral Hypoperfusion Model. Neuromolecular Med 2019; 21:391-400. [PMID: 31123914 PMCID: PMC6882763 DOI: 10.1007/s12017-019-08541-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/04/2019] [Indexed: 11/24/2022]
Abstract
High-mobility group box-1 (HMGB1) is a nuclear protein that promotes inflammation during the acute phase post-stroke, and enhances angiogenesis during the delayed phase. Here, we evaluated whether indirect revascularization surgery with HMGB1 accelerates brain angiogenesis in a chronic cerebral hypoperfusion model. Seven days after hypoperfusion induction, encephalo-myo-synangiosis (EMS) was performed with or without HMGB1 treatment into the temporal muscle. We detected significant increments in cortical vasculature (p < 0.01), vascular endothelial growth factor (VEGF) expression in the temporal muscle (p < 0.05), and ratio of radiation intensity on the operated side compared with the non-operated side after EMS in the HMGB1-treated group than in the control group (p < 0.01). Altogether, HMGB1 with EMS in a chronic hypoperfusion model promoted brain angiogenesis in a VEGF-dependent manner, resulting in cerebral blood flow improvement. This treatment may be an effective therapy for patients with moyamoya disease.
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Affiliation(s)
- Shingo Nishihiro
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1, Shikata-cho, kita-ku, Okayama, 700-8558, Japan.
| | - Tomohito Hishikawa
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1, Shikata-cho, kita-ku, Okayama, 700-8558, Japan
| | - Masafumi Hiramatsu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1, Shikata-cho, kita-ku, Okayama, 700-8558, Japan
| | - Naoya Kidani
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1, Shikata-cho, kita-ku, Okayama, 700-8558, Japan
| | - Yu Takahashi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1, Shikata-cho, kita-ku, Okayama, 700-8558, Japan
| | - Satoshi Murai
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1, Shikata-cho, kita-ku, Okayama, 700-8558, Japan
| | - Kenji Sugiu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1, Shikata-cho, kita-ku, Okayama, 700-8558, Japan
| | - Yusuke Higaki
- Department of Pharmaceutical Analytical Chemistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, 1-1-1, Tsushima naka, kita-ku, Okayama, 700-8530, Japan
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1, Shikata-cho, kita-ku, Okayama, 700-8558, Japan
| | - Cesario V Borlongan
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1, Shikata-cho, kita-ku, Okayama, 700-8558, Japan
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Yu L, Ma L, Huang Z, Shi Z, Wang R, Zhao Y, Zhang D. Revascularization Surgery in Patients with Ischemic-Type Moyamoya Disease: Predictors for Postoperative Stroke and Long-Term Outcomes. World Neurosurg 2019; 128:e582-e596. [PMID: 31059856 DOI: 10.1016/j.wneu.2019.04.214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recurrent stroke after surgical revascularization is still a big issue for moyamoya disease (MMD). This study aims to identify predictors for postoperative stroke and unfavorable outcome in ischemic-type MMD. METHODS We identified a consecutive series of patients with ischemic-type MMD who underwent revascularization between January 2005 and December 2012. Predictors for postoperative stroke and functional outcomes were assessed with logistic and Cox regression analysis. RESULTS A total of 346 patients underwent 437 revascularization procedures and the mean follow-up period was 4.0 years. The incidence of perioperative stroke was 6.9%. Being adult at onset (odds ratio [OR], 5.033; 95% confidence interval [CI], 1.447-17.506; P = 0.011) and posterior cerebral artery (PCA) stenosis (OR, 3.364; 95% CI, 1.588-7.265; P = 0.002) before surgery were predictors of perioperative stroke. The annual subsequent stroke rate beyond 30 days after surgery was 1.2%. Subsequent stroke events tended to occur throughout the first 5 years after surgery in adults, whereas in children they mainly occurred within the first 2 years after surgery. Age at onset (OR, 1.025; 95% CI, 1.003-1.048; P = 0.023), ischemic stroke or transient ischemic attack at presentation (OR, 2.703; 95% CI, 1.062-6.875; P = 0.037), and PCA involvement (OR, 2.664; 95% CI, 1.462-4.854; P = 0.001) were associated with higher risk of overall postoperative stroke. PCA involvement (OR, 2.62; 95% CI, 1.33-5.15; P = 0.005), internal carotid artery supraclinoid segment occlusion (OR, 2.76; 95% CI, 1.27-6.03; P = 0.011), and older age at onset (OR, 1.03; 95% CI, 1.01-1.05; P = 0.033) were predictive of unfavorable outcome. CONCLUSIONS Patients with ischemic-type MMD at an older age and more severe angiopathy might be at higher risk of recurrent stroke and unfavorable outcome after revascularization.
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Affiliation(s)
- Lebao Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Li Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Zheng Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.
| | - Zhiyong Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Disease, Beijing, China
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Predictive factors for acute thrombogenesis occurring immediately after bypass procedure for moyamoya disease. Neurosurg Rev 2019; 43:609-617. [PMID: 30767097 DOI: 10.1007/s10143-019-01086-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/18/2019] [Accepted: 02/07/2019] [Indexed: 12/11/2022]
Abstract
Extracranial-to-intracranial (EC-IC) bypass surgery is an effective treatment for patients with moyamoya disease and other conditions. Some patients with moyamoya disease have a risk of acute thrombogenesis at the anastomotic site just after bypass surgery. The purpose of this study was to study risk factors of acute thrombogenesis and determine effective countermeasures. This study included 48 patients (66 EC-IC bypass procedures) with moyamoya disease and 52 controls (54 procedures) without moyamoya disease. The development of acute thrombogenesis was compared between the moyamoya disease and control groups. In the moyamoya disease group, clinical and radiological characteristics were assessed with respect to acute thrombogenesis. In the patients with acute thrombogenesis, causes of technical problems were retrospectively examined. The incidence of acute thrombogenesis was significantly higher in the moyamoya disease group than those in the control group. In the moyamoya disease group, acute thrombogenesis was observed in seven patients. In the moyamoya disease group, the magnetic resonance angiography (MRA) scores were significantly higher in patients with acute thrombogenesis than those in the patients without acute thrombogenesis. In the multivariate analysis, the predictive factor of acute thrombogenesis in moyamoya disease was a high MRA score (odds ratio, 2.336; p = 0.009). During EC-IC bypass surgery for moyamoya disease, acute thrombogenesis should be considered to obtain a high patency rate, particularly in patients with high MRA scores. Acute thrombogenesis will not influence morbidity if proper countermeasures are followed; therefore, the prediction and recognition of white thrombus are important for a successful bypass surgery.
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Dlamini N, Muthusami P, Amlie-Lefond C. Childhood Moyamoya: Looking Back to the Future. Pediatr Neurol 2019; 91:11-19. [PMID: 30424960 DOI: 10.1016/j.pediatrneurol.2018.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/04/2018] [Accepted: 10/14/2018] [Indexed: 11/26/2022]
Abstract
Moyamoya is a chronic, progressive steno-occlusive arteriopathy that typically affects the anterior circulation arteries of the circle of Willis. A network of deep thalamoperforating and lenticulostriate collaterals develop to by-pass the occlusion giving rise to the characteristic angiographic "puff of smoke" appearance. Moyamoya confers a lifelong risk of stroke and neurological demise, with peak age of presentation in childhood ranging between five and 10 years. Moyamoya disease refers to patients who do not have a comorbid condition, whereas moyamoya syndrome refers to patients in whom moyamoya occurs in association with an acquired or inherited disorder such as sickle cell disease, neurofibromatosis type-1 or trisomy 21. The incidence of moyamoya disease and moyamoya syndrome demonstrates geographic and ethnic variation, with a predominance of moyamoya disease in East-Asian populations. Antiplatelet therapy and surgical revascularization procedures are the mainstay of management, as there are no available treatments to slow the progression of the arteriopathy. Future research is required to address the major gaps that remain in our understanding of the pathologic basis, optimal timing for surgery, and determinants of outcome in this high-stroke risk condition of childhood.
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Affiliation(s)
- Nomazulu Dlamini
- Department of Neurology, The Hospital for Sick Children, Toronto, Canada.
| | - Prakash Muthusami
- Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
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Lin YH, Kuo MF, Lu CJ, Lee CW, Yang SH, Huang YC, Liu HM, Chen YF. Standardized MR Perfusion Scoring System for Evaluation of Sequential Perfusion Changes and Surgical Outcome of Moyamoya Disease. AJNR Am J Neuroradiol 2019; 40:260-266. [PMID: 30655253 DOI: 10.3174/ajnr.a5945] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 12/01/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Simple-but-precise evaluation of cerebral perfusion is crucial for the treatment of Moyamoya disease. We aimed to develop a standardized scoring system for MR perfusion suitable for Moyamoya disease evaluation and investigate the postoperative serial changes and outcome predictors. MATERIALS AND METHODS From January 2013 to December 2016, patients diagnosed with Moyamoya disease and receiving indirect revascularization were recruited prospectively. Clinical data and serial imaging studies were analyzed. The TTP maps were standardized using cerebellar reference values. We developed a scoring system of standardized TTP maps: 14 points for each hemisphere with higher points indicating better perfusion. RESULTS In total, 24 children (4-17 years of age, 41 hemispheres) and 20 adults (18-51 years of age, 34 hemispheres) were included. The mean preoperative TTP scores were higher in children (7.34 ± 3.90) than in adults (4.88 ± 3.24). The standardized TTP maps revealed dynamic improvement with an increase in the corresponding scores at the 1-, 3-, and 6-month postoperative follow-ups; the scores stabilized after 6 months. The mean improvement in the 6-month scores of the pediatric and adult groups was 4.15 ± 3.55 and 6.03 ± 3.04, respectively. The 6-month TTP score improvements were associated with Matsushima grades. If we took score improvement as the outcome, the preoperative TTP score was the only significant predictor in multivariable analysis. CONCLUSIONS The standardized TTP maps and scoring system facilitated the quantification of the sequential perfusion changes during Moyamoya disease treatment. The preoperative perfusion status was the only predictor of indirect revascularization outcome.
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Affiliation(s)
- Y-H Lin
- From the Department of Medical Imaging (Y.-H.L., C.-J.L., C.-W.L., Y.-F.C.)
| | - M-F Kuo
- Division of Neurosurgery (M.-F.K., S.-H.Y.), Department of Surgery, National Taiwan University Hospital, Taiwan
| | - C-J Lu
- From the Department of Medical Imaging (Y.-H.L., C.-J.L., C.-W.L., Y.-F.C.)
| | - C-W Lee
- From the Department of Medical Imaging (Y.-H.L., C.-J.L., C.-W.L., Y.-F.C.)
| | - S-H Yang
- Division of Neurosurgery (M.-F.K., S.-H.Y.), Department of Surgery, National Taiwan University Hospital, Taiwan
| | - Y-C Huang
- Department of Medical Imaging (Y.-C.H.), Min-Sheng General Hospital, Taoyuan, Taiwan
| | - H-M Liu
- Department of Radiology (H.-M.L.), Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Y-F Chen
- From the Department of Medical Imaging (Y.-H.L., C.-J.L., C.-W.L., Y.-F.C.)
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75
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Zheng J, Yu LB, Dai KF, Zhang Y, Wang R, Zhang D. Clinical Features, Surgical Treatment, and Long-Term Outcome of a Multicenter Cohort of Pediatric Moyamoya. Front Neurol 2019; 10:14. [PMID: 30723451 PMCID: PMC6349739 DOI: 10.3389/fneur.2019.00014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/07/2019] [Indexed: 11/22/2022] Open
Abstract
Objective: This study aims to investigate the clinical features, long-term outcomes, and prognostic predictors of a multicenter cohort of children with moyamoya disease. Methods: A series of 303 consecutive pediatric moyamoya disease (MMD) patients were screened in the present study. The clinical characteristics were retrospectively collected, and long-term outcomes was evaluated. Furthermore, logistic regression analyses were performed to determine the prognostic predictors for the clinical outcome. Results: The mean onset age at diagnosis was 9.4 years old. The gender ratio (girl-to-boy ratio) was 1.1:1.0. Among these 303 patients, 13 patients underwent different surgical modalities in bilateral hemispheres, while eight patients failed to follow-up, and were excluded. Therefore, a total of 282 patients were analyzed. Among these patients, 17 patients underwent combined bypass (CB), 47 patients underwent direct bypass (DB), 150 patients underwent indirect bypass (IB), and 68 patients underwent conservative treatment. Furthermore, recurrent stroke events were observed in 35 patients (12.4%). The Kaplan-Meier analysis demonstrated that there was no significant difference in either ischemia or hemorrhage-free time among the different surgical modalities (P = 0.67 and 0.79, respectively). Furthermore, longer ischemia-free time was observed in the surgical group, when compared to the conservative group (P < 0.01). In addition, 82.7% (177/214) of patients who underwent surgical treatment obtained good outcomes (mRS 0-1), which were significantly higher than the rate of patients who underwent conservative treatment (52.9%, 36/68; P < 0.01). The rate of patients with improved symptoms was also significantly different (93.0 vs. 16.2%, P < 0.01). However, no significant difference was observed in the rate of good outcomes, disability, and improved symptoms among the different surgical modalities. The logistic regression analyses revealed that postoperative ischemic events were the only risk factor associated with unfavorable clinical outcome (OR:3.463; 95% CI:1.436–8.351; P < 0.01). Conclusion: CB, DB, and IB might have similar effects on long-term clinical outcome in pediatric MMD. However, surgical revascularization is superior, when compared to conservative treatment. Furthermore, postoperative ischemic events were confirmed as potential prognostic factors associated with unfavorable clinical outcome.
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Affiliation(s)
- Jun Zheng
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Neurosurgery, The Second Hospital of Hebei Medical University, Hebei, China
| | - Le-Bao Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Ke-Fang Dai
- Department of Neurosurgery, Xingtai Third Hospital, Shandong, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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76
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Wang C, Zhao M, Wang J, Wang S, Zhang D, Wang K, Zhao J. Encephaloduroarteriosynangiosis for Pediatric Moyamoya Disease: A Single-Center Experience With 67 Cases in China. J Child Neurol 2018; 33:901-908. [PMID: 30246586 DOI: 10.1177/0883073818798515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study is to investigate the surgical results and long-term outcomes of encephaloduroarteriosynangiosis for moyamoya disease in pediatric patients. We performed a retrospective analysis of 67 pediatric patients with moyamoya disease who underwent encephaloduroarteriosynangiosis in Beijing Tiantan Hospital. The case series included 36 boys and 31 girls. All the patients underwent surgical revascularization, and a total of 93 encephaloduroarteriosynangiosis procedures were performed (41 unilateral, 26 bilateral). The mean follow-up period after surgery was 30 months. During follow-up, ischemic stroke events were detected in 5 patients and the stroke rate for pediatric patients who underwent encephaloduroarteriosynangiosis procedure was 7.1% per patient-years. At the last follow-up, favorable outcomes (modified Rankin Scale score ≤ 2) were observed in 65 cases (97.0%). Our study suggests that long-term surgical outcome of encephaloduroarteriosynangiosis in pediatric moyamoya disease patients is satisfactory, and this technique has a positive impact on the prevention of stroke recurrence.
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Affiliation(s)
- Chengjun Wang
- 1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.,2 China National Clinical Research Center for Neurological Diseases, Beijing, PR China.,3 Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China.,4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Meng Zhao
- 1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.,2 China National Clinical Research Center for Neurological Diseases, Beijing, PR China.,3 Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China.,4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Jia Wang
- 1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.,2 China National Clinical Research Center for Neurological Diseases, Beijing, PR China.,3 Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China.,4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Shuo Wang
- 1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.,2 China National Clinical Research Center for Neurological Diseases, Beijing, PR China.,3 Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China.,4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Dong Zhang
- 1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.,2 China National Clinical Research Center for Neurological Diseases, Beijing, PR China.,3 Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China.,4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Kai Wang
- 5 Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Jizong Zhao
- 1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.,2 China National Clinical Research Center for Neurological Diseases, Beijing, PR China.,3 Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China.,4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
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Bao XY, Wang QN, Zhang Y, Zhang Q, Li DS, Yang WZ, Zhang ZS, Zong R, Han C, Duan L. Epidemiology of Moyamoya Disease in China: Single-Center, Population-Based Study. World Neurosurg 2018; 122:e917-e923. [PMID: 30404059 DOI: 10.1016/j.wneu.2018.10.175] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/23/2018] [Accepted: 10/26/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND To our knowledge, no previous study has described the nationwide epidemiologic features of moyamoya disease (MMD) in China. We describe the epidemiologic features including the relative prevalence, age distribution, gender distribution, and initial clinical manifestations of patients with MMD treated at a single institution in China. METHODS Our cohort included 4128 patients with MMD. Their demographic and clinical characteristics were obtained by retrospective chart review. RESULTS The median age for the onset of symptoms was 30.36 years. The age distribution of patients with MMD was bimodal, with the highest peak detection rate at 35-45 years of age and a smaller peak at 5-9 years of age. The ratio of female-to-male patients was 1:1. The disease occurred mainly in the Han people and was rarely seen in minority nationalities. In our cohort, transient ischemic attack was the most common initial clinical manifestation (48.13%). The other initial manifestations included infarction (22.62%), hemorrhage (16.45%), and headache 230/4128 (5.57%). In north and northeast China, the ischemic type was more predominate while the hemorrhagic type was relatively rare. However, the percentage of hemorrhagic type in East China was higher than anywhere else in China. CONCLUSIONS This study confirmed some unique epidemiologic features as the studies previously reported in China, but it also revealed some new sight and tendency about moyamoya in China. As a lack of national epidemiologic studies, this study indicated the outline of moyamoya in China.
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Affiliation(s)
- Xiang-Yang Bao
- Department of Neurosurgery, The Center for Cerebral Vascular Disease, Academy of Military Medical Science, Beijing, China
| | - Qian-Nan Wang
- Department of Neurosurgery, The Center for Cerebral Vascular Disease, Academy of Military Medical Science, Beijing, China
| | - Yong Zhang
- Department of Neurosurgery, The Center for Cerebral Vascular Disease, Academy of Military Medical Science, Beijing, China
| | - Qian Zhang
- Department of Neurosurgery, The Center for Cerebral Vascular Disease, Academy of Military Medical Science, Beijing, China
| | - De-Sheng Li
- Department of Neurosurgery, The Center for Cerebral Vascular Disease, Academy of Military Medical Science, Beijing, China
| | - Wei-Zhong Yang
- Department of Neurosurgery, The Center for Cerebral Vascular Disease, Academy of Military Medical Science, Beijing, China
| | - Zheng-Shan Zhang
- Department of Neurosurgery, The Center for Cerebral Vascular Disease, Academy of Military Medical Science, Beijing, China
| | - Rui Zong
- Department of Neurosurgery, The Center for Cerebral Vascular Disease, Academy of Military Medical Science, Beijing, China
| | - Cong Han
- Department of Neurosurgery, The Center for Cerebral Vascular Disease, Academy of Military Medical Science, Beijing, China
| | - Lian Duan
- Department of Neurosurgery, The Center for Cerebral Vascular Disease, Academy of Military Medical Science, Beijing, China.
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78
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Gadgil N, Lam S, Pyarali M, Paldino M, Pan IW, Dauser RC. Indirect revascularization with the dural inversion technique for pediatric moyamoya disease: 20-year experience. J Neurosurg Pediatr 2018; 22:541-549. [PMID: 30117790 DOI: 10.3171/2018.5.peds18163] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/25/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVENumerous surgical procedures facilitate revascularization of the ischemic brain in patients with moyamoya disease. Dural inversion is a technique in which flaps of dura mater centered around the middle meningeal artery are inverted, encouraging the formation of a rich collateral blood supply. This procedure has been used in combination with encephaloduroarteriosynangiosis for more than 20 years at the authors' institution for the treatment of pediatric moyamoya disease. The objective of this study was to describe the clinical and radiographic outcomes for a cohort of consecutive pediatric moyamoya patients undergoing dural inversion.METHODSClinical and radiographic data on patients who had undergone dural inversion in the period from 1997 to 2016 were reviewed. Univariate and multivariate logistic regression and Kaplan-Meier analyses were performed to assess the risk of postoperative stroke, functional outcome, and the angiographic degree of revascularization.RESULTSDural inversion was performed on 169 hemispheres in 102 patients. Median follow-up was 4.3 years. Six patients (3.6% of hemispheres) suffered postoperative ischemic or hemorrhagic stroke. Overall mortality was 1.0%. Good postoperative neurological status (modified Rankin Scale [mRS] score ≤ 2) was observed in 90 patients (88%); preoperative and postoperative mRS scores showed significant improvement (p < 0.001). Eighty-six percent of hemispheres had Matsushima grade A or B revascularization. Younger age was associated with postoperative stroke and poor functional outcome. Patients with secondary moyamoya syndrome had a significantly worse radiographic outcome. The cumulative 5-year Kaplan-Meier risk for stroke was 6.4%.CONCLUSIONSDural inversion is a useful technique of cerebral revascularization in pediatric moyamoya disease. A 20-year experience demonstrates the safety and efficacy of this technique with a relatively low rate of postoperative stroke, good functional outcomes, and favorable angiographic results.
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Affiliation(s)
- Nisha Gadgil
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital; and
| | - Sandi Lam
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital; and
| | - Monika Pyarali
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital; and
| | - Michael Paldino
- 2Department of Radiology, Texas Children's Hospital, Houston, Texas
| | - I-Wen Pan
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital; and
| | - Robert C Dauser
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital; and
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79
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Egashira Y, Yoshimura S, Enomoto Y, Nakayama N, Iwama T. Single-Stage Direct Revascularization for Bilateral Anterior Cerebral Artery Regions in Pediatric Moyamoya Disease: A Technical Note. World Neurosurg 2018; 118:324-328. [DOI: 10.1016/j.wneu.2018.07.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/07/2018] [Accepted: 07/09/2018] [Indexed: 11/16/2022]
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80
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Chiba T, Setta K, Shimada Y, Yoshida J, Fujimoto K, Tsutsui S, Yoshida K, Kobayashi M, Kubo Y, Fujiwara S, Terasaki K, Ogasawara K. Comparison of Effects between Clopidogrel and Cilostazol on Cerebral Perfusion in Nonsurgical Adult Patients with Symptomatically Ischemic Moyamoya Disease: Subanalysis of a Prospective Cohort. J Stroke Cerebrovasc Dis 2018; 27:3373-3379. [PMID: 30174225 DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/11/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Adult patients with symptomatically ischemic moyamoya disease (MMD) initially undergo medical treatment alone including antiplatelet drugs when symptomatic cerebral hemispheres do not exhibit hemodynamic compromise. The purpose of the present study subanalyzing the same patient cohort used in a previous study was to determine which antiplatelet drug, clopidogrel or cilostazol, provides better improvement of cerebral perfusion in such patients. METHODS All patients without cerebral misery perfusion on 15O gas positron emission tomography (PET) did not undergo revascularization surgery and were treated with medication alone, including antiplatelet therapy. Patients ≥50years and <50years initially received clopidogrel and cilostazol, respectively. When a patient suffered side effects of an antiplatelet drug, they were switched to the other antiplatelet drug. Cerebral blood flow (CBF) in the symptomatic hemisphere was measured at inclusion and at 2years after inclusion using 15O gas PET. RESULTS Of 68 patients, 31 and 38 were treated with clopidogrel and cilostazol, respectively, for 2years after inclusion. For patients treated with clopidogrel, CBF did not differ between first and second PET. For patients treated with cilostazol, CBF was significantly greater in the second PET than in the first PET. On multivariate analysis, cilostazol administration was an independent predictor of CBF improvement in the symptomatic hemisphere (95% confidence interval, 1.34-139.20; P =.0271). CONCLUSIONS Cilostazol improves cerebral perfusion better than clopidogrel in adult patients with symptomatically ischemic MMD not accompanied by misery perfusion.
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Affiliation(s)
- Takayuki Chiba
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Kengo Setta
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Yasuyoshi Shimada
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Jun Yoshida
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Kentaro Fujimoto
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Shouta Tsutsui
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Masakazu Kobayashi
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Shunrou Fujiwara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Kazunori Terasaki
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan.
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81
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Deng X, Ge P, Wang S, Zhang D, Zhang Y, Wang R, Zhao J. Treatment of Moyamoya Disease. Neurosurgery 2018; 65:62-65. [PMID: 31076784 DOI: 10.1093/neuros/nyy114] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/06/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical Uni-versity, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Translational Engineering Center for 3D printer in Clinical Neuroscience, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Peicong Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical Uni-versity, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Translational Engineering Center for 3D printer in Clinical Neuroscience, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical Uni-versity, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Translational Engineering Center for 3D printer in Clinical Neuroscience, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical Uni-versity, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Translational Engineering Center for 3D printer in Clinical Neuroscience, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical Uni-versity, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Translational Engineering Center for 3D printer in Clinical Neuroscience, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical Uni-versity, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Translational Engineering Center for 3D printer in Clinical Neuroscience, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical Uni-versity, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Translational Engineering Center for 3D printer in Clinical Neuroscience, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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82
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Omer S, Zbyszynska R, Kirthivasan R. Peek through the smoke: a report of moyamoya disease in a 32-year-old female patient presenting with ischaemic stroke. BMJ Case Rep 2018; 2018:bcr-2017-221685. [PMID: 30093460 DOI: 10.1136/bcr-2017-221685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Moyamoya disease is a vasculopathy causing chronic progressive stenosis and occlusion of the large arteries of the circle of Willis that could lead to brain ischaemia. The condition may also present with haemorrhagic strokes. This is a case report of moyamoya disease in a 32-year-old woman presenting with ischaemic stroke. The report describes her inpatient stay and investigations and findings.The report reviews the main aspects of moyamoya disease definition, epidemiology, clinical features, diagnosis, classification and treatment. This case is interesting because her first presentation occurred after 3 months of her second delivery. Whether the different physiological stresses of pregnancy, child birth and puerperium have had some effect in accelerating the pathogenesis of her moyamoya disease remains unknown. 1.
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Affiliation(s)
- Siddiq Omer
- Care of the Elderly Medicine, Mid Essex Hospital Services NHS Trust, Chelmsford, UK
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83
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Zhang Y, Bao XY, Duan L, Yang WZ, Li DS, Zhang ZS, Han C, Zhao F, Zhang Q, Wang QN. Encephaloduroarteriosynangiosis for pediatric moyamoya disease: long-term follow-up of 100 cases at a single center. J Neurosurg Pediatr 2018; 22:173-180. [PMID: 29856299 DOI: 10.3171/2018.2.peds17591] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The object of this study was to summarize the long-term effect of encephaloduroarteriosynangiosis (EDAS) for the treatment of pediatric moyamoya disease (MMD) and to investigate factors influencing the clinical outcomes of EDAS. METHODS Clinical features, angiographic findings, and clinical outcomes were analyzed among MMD patients younger than 18 years who had been treated with EDAS between 2002 and 2007 at the authors' institution. The Kaplan-Meier method was used to estimate stroke risk after EDAS. Predictors of neurological outcome were assessed. RESULTS One hundred fifteen patients were identified. The mean age at symptom onset was 7.3 ± 4.0 years. The incidence of familial MMD was 11.3%. The female/male ratio was 1:1.16. A total of 232 EDAS procedures were performed, and the incidence of postoperative complications was 3%. Postoperative digital subtraction angiography was performed in 54% of the patients, and about 80% of the hemispheres showed good or excellent results. Neovascularization showed significant correlations with delay time (from symptom onset to first operation), Suzuki stage, and preoperative stroke (all p < 0.05). Clinical follow-up was available in 100 patients with a mean follow-up of 124.4 ± 10.5 months. Ten-year cumulative survival was 96.5% after surgery, and the risk of stroke was 0.33%/person-year. An independent life with no significant disability was reported by 92% of the patients. A good outcome correlated with a low Suzuki stage (p = 0.001). Older children and those without preoperative stroke had better clinical outcomes (p < 0.05). CONCLUSIONS On the basis of long-term follow-up data, the authors concluded that EDAS is a safe and effective treatment for pediatric MMD, can reduce the risk of subsequent neurological events, and can improve quality of life. The risk of ischemia-related complications was higher in younger patients, and older children showed better outcomes. Compensation was greater with more prominent cerebral ischemia. The long-term clinical outcome largely depended on the presence and extent of preoperative stroke.
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Affiliation(s)
- Yong Zhang
- 1Department of Neurosurgery, 307th Hospital of People's Liberation Army, 307 Clinical College, Anhui Medical University; and.,2Department of Neurosurgery, 307th Hospital of People's Liberation Army, The Center for Cerebral Vascular Disease, PLA, Beijing, People's Republic of China
| | - Xiang-Yang Bao
- 2Department of Neurosurgery, 307th Hospital of People's Liberation Army, The Center for Cerebral Vascular Disease, PLA, Beijing, People's Republic of China
| | - Lian Duan
- 1Department of Neurosurgery, 307th Hospital of People's Liberation Army, 307 Clinical College, Anhui Medical University; and.,2Department of Neurosurgery, 307th Hospital of People's Liberation Army, The Center for Cerebral Vascular Disease, PLA, Beijing, People's Republic of China
| | - Wei-Zhong Yang
- 2Department of Neurosurgery, 307th Hospital of People's Liberation Army, The Center for Cerebral Vascular Disease, PLA, Beijing, People's Republic of China
| | - De-Sheng Li
- 2Department of Neurosurgery, 307th Hospital of People's Liberation Army, The Center for Cerebral Vascular Disease, PLA, Beijing, People's Republic of China
| | - Zheng-Shan Zhang
- 2Department of Neurosurgery, 307th Hospital of People's Liberation Army, The Center for Cerebral Vascular Disease, PLA, Beijing, People's Republic of China
| | - Cong Han
- 2Department of Neurosurgery, 307th Hospital of People's Liberation Army, The Center for Cerebral Vascular Disease, PLA, Beijing, People's Republic of China
| | - Feng Zhao
- 2Department of Neurosurgery, 307th Hospital of People's Liberation Army, The Center for Cerebral Vascular Disease, PLA, Beijing, People's Republic of China
| | - Qian Zhang
- 2Department of Neurosurgery, 307th Hospital of People's Liberation Army, The Center for Cerebral Vascular Disease, PLA, Beijing, People's Republic of China
| | - Qian-Nan Wang
- 2Department of Neurosurgery, 307th Hospital of People's Liberation Army, The Center for Cerebral Vascular Disease, PLA, Beijing, People's Republic of China
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Shang S, Zhou D, Ya J, Li S, Yang Q, Ding Y, Ji X, Meng R. Progress in moyamoya disease. Neurosurg Rev 2018; 43:371-382. [PMID: 29911252 DOI: 10.1007/s10143-018-0994-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/29/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022]
Abstract
Moyamoya disease is characterized by progressive stenosis or occlusion of the intracranial portion of the internal carotid artery and their proximal branches, resulting in ischemic or hemorrhagic stroke with high rate of disability and even death. So far, available treatment strategies are quite limited, and novel intervention method is being explored. This review encapsulates current advances of moyamoya disease on the aspects of epidemiology, etiology, clinical features, imaging diagnosis and treatment. In addition, we also bring forward our conjecture, which needs to be testified by future research.
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Affiliation(s)
- Shuling Shang
- Departments of Neurology, Radiology and Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China.,Department of Neurology, Xiehe Hospital, Tangshan, 063000, China
| | - Da Zhou
- Departments of Neurology, Radiology and Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China
| | - Jingyuan Ya
- Departments of Neurology, Radiology and Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China
| | - Sijie Li
- Departments of Neurology, Radiology and Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China
| | - Qi Yang
- Departments of Neurology, Radiology and Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Yuchuan Ding
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Xunming Ji
- Departments of Neurology, Radiology and Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China
| | - Ran Meng
- Departments of Neurology, Radiology and Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China. .,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China.
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Houba A, Laaribi N, Meziane M, Jaafari A, Abouelalaa K, Bensghir M. Moyamoya disease in a Moroccan baby: a case report. J Med Case Rep 2018; 12:165. [PMID: 29895322 PMCID: PMC5998455 DOI: 10.1186/s13256-018-1642-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 03/06/2018] [Indexed: 11/16/2022] Open
Abstract
Background A stroke in a baby is uncommon, recent studies suggested that their incidence is rising. Moyamoya disease is one of the leading causes of stroke in babies. This condition is mostly described in Japan. In Morocco, moyamoya disease has rarely been reported and a few cases were published. We report a rare Moroccan case of a 23-month-old baby boy who presented with left-sided hemiparesis and was diagnosed as having moyamoya disease. Case presentation A 23-month-old full-term Moroccan baby boy born to a non-consanguineous couple was referred to our hospital with the complaint of sudden onset left-sided hemiparesis. On neurological examination, there were no signs of meningeal irritation, his gait was hemiplegic, tone was decreased over left side, power was 2/5 over left upper and lower limb, and deep tendon reflexes were exaggerated. Preliminary neuroimaging suggested an arterial ischemic process. Clinical and laboratory evaluation excluded hematologic, metabolic, and vasculitic causes. Cerebral angiography confirmed the diagnosis of moyamoya disease. Our patient was treated with acetylsalicylic acid 5 mg/kg per day and referred to follow-up with pediatric neurosurgeon. Cerebral revascularization surgery using encephaloduroarteriosynangiosis was performed. At 8-month follow-up, his hemiparesis had improved and no further ischemic events had occurred. Conclusion This case highlights the importance of considering moyamoya disease to be one of the classic etiologies of acute ischemic strokes in children from North Africa. It also emphasizes the rare presentation among the African population and the use of neurovascular imaging techniques to facilitate diagnosis of moyamoya disease.
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Affiliation(s)
- Abdelhafid Houba
- Department of Anesthesiology, Military Hospital Mohammed V Rabat, Faculty of Medicine and Pharmacy, University of Mohammed V, Souissi, district Riyadh, BP: 1000, Rabat, Morocco.
| | - Nisrine Laaribi
- Department of Pediatric, Children's Hospital Rabat, Faculty of Medicine and Pharmacy, University of Mohammed V, Souissi, Rabat, Morocco
| | - Mohammed Meziane
- Department of Anesthesiology, Military Hospital Mohammed V Rabat, Faculty of Medicine and Pharmacy, University of Mohammed V, Souissi, district Riyadh, BP: 1000, Rabat, Morocco
| | - Abdelhamid Jaafari
- Department of Anesthesiology, Military Hospital Mohammed V Rabat, Faculty of Medicine and Pharmacy, University of Mohammed V, Souissi, district Riyadh, BP: 1000, Rabat, Morocco
| | - Khalil Abouelalaa
- Department of Anesthesiology, Military Hospital Mohammed V Rabat, Faculty of Medicine and Pharmacy, University of Mohammed V, Souissi, district Riyadh, BP: 1000, Rabat, Morocco
| | - Mustapha Bensghir
- Department of Anesthesiology, Military Hospital Mohammed V Rabat, Faculty of Medicine and Pharmacy, University of Mohammed V, Souissi, district Riyadh, BP: 1000, Rabat, Morocco
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86
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Kim W, Lee EY, Park SE, Park EK, Kim JS, Kim DS, Shim KW. Neuropsychological impacts of indirect revascularization for pediatric moyamoya disease. Childs Nerv Syst 2018; 34:1199-1206. [PMID: 29679197 DOI: 10.1007/s00381-018-3804-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Moyamoya disease (MMD) commonly leads to neurocognitive impairment. This study was carried out to show that temporal encephaloduroarteriosynangiosis (EDAS) has a positive neuropsychological impact on pediatric MMD patients. METHODS Fifty-five participants diagnosed with MMD from 2008 to 2014 were included in this retrospective study. The mean age at the preoperative evaluation was 9.5 years and the mean age at postoperative evaluation was 10.4. The average interval of initial and follow-up test was 10 months. K-WISC-III, Rey-Kim memory test, Children's Color Trails test (CCTT), Wisconsin Card Sorting Test (WCST), and Advanced Test of Attention (ATA) were used to evaluate patient's neurocognitive profile. RESULTS In this study, preoperative and postoperative neuropsychological fields were compared. Prior operation, pediatric MMD patients showed 54.2% deficit of inattention but only around 2.5% deficit in verbal memory recall function. There was a significant increase of performance IQ and PO score component of PIQ improved almost 10 scores after surgery. For memorial function, there was an improvement of approximately 10 scores in MQ after the surgery. This study also showed parietal activation following surgical treatment which enhanced the ability to interpret visual materials, to register and to retrieve visual information. Interestingly, despite the parietal cover surgery, there was a significant improvement of performance on WCST and CCTT measuring the prefrontal executive function. Concerning failure to maintain set, no significant postoperative improvements were made. However, simple and selective visual attention on ATA was significantly improved postoperatively. CONCLUSIONS The results from neuropsychological field comparison testifies the effectiveness of temporal EDAS in pediatric MMD patients. The surgery not only enhances the blood flow in operative regions, but it also improves the broad cerebral function including frontoparietal domains. Such alteration leads to overall advancement in cognitive function which are impaired due to MMD.
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Affiliation(s)
- WooHyun Kim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seodaemungu, Seoul, South Korea
| | - Eun-Young Lee
- Happience Psychology Clinic attached to Korea Jeail Psychiatric Clinic, Seoul, South Korea
| | - Seong-Eun Park
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seodaemungu, Seoul, South Korea
| | - Eun-Kyung Park
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seodaemungu, Seoul, South Korea
| | - Ju-Seong Kim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seodaemungu, Seoul, South Korea
| | - Dong-Seok Kim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seodaemungu, Seoul, South Korea
| | - Kyu-Won Shim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seodaemungu, Seoul, South Korea.
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Funaki T, Takahashi JC, Miyamoto S. Late Cerebrovascular Events and Social Outcome after Adolescence: Long-term Outcome of Pediatric Moyamoya Disease. Neurol Med Chir (Tokyo) 2018; 58:240-246. [PMID: 29780072 PMCID: PMC6002682 DOI: 10.2176/nmc.ra.2018-0026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In this article, the authors review the literature related to long-term outcome of pediatric moyamoya disease, focusing on late cerebrovascular events and social outcome of pediatric patients once they reach adulthood. Late-onset de novo hemorrhage is rare but more serious than recurrence of ischemic stroke. Long-term follow-up data on Asian populations suggest that the incidence of de novo hemorrhage might increase at age 20 or later, even more than 10 years after bypass surgery. Social adaptation difficulty, possibly related to cognitive impairment caused by frontal ischemia, continues in 10-20% of patients after they reach adulthood, even if no significant disability is present in daily life. A treatment strategy aimed at improving long-term outcome and careful follow-up might be required.
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Affiliation(s)
- Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Jun C Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
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88
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Hervé D, Kossorotoff M, Bresson D, Blauwblomme T, Carneiro M, Touze E, Proust F, Desguerre I, Alamowitch S, Bleton JP, Borsali A, Brissaud E, Brunelle F, Calviere L, Chevignard M, Geffroy-Greco G, Faesch S, Habert MO, De Larocque H, Meyer P, Reyes S, Thines L, Tournier-Lasserve E, Chabriat H. French clinical practice guidelines for Moyamoya angiopathy. Rev Neurol (Paris) 2018. [PMID: 29519672 DOI: 10.1016/j.neurol.2017.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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89
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Bao XY, Zhang Y, Wang QN, Zhang Q, Wang H, Zhang ZS, Li DS, Duan L. Long-term Outcomes After Encephaloduroarteriosynangiosis in Adult Patients with Moyamoya Disease Presenting with Ischemia. World Neurosurg 2018; 115:e482-e489. [PMID: 29684518 DOI: 10.1016/j.wneu.2018.04.076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND In adult Moyamoya disease (MMD), there remains controversy about the effectiveness of revascularization surgeries because randomized studies have not been performed to compare the efficacy of surgical techniques. This study was conducted to assess the most appropriate surgical treatment for adult patients with MMD. METHODS Encephaloduroarteriosynangiosis (EDAS) was performed on 247 hemispheres in 145 patients. The clinical and demographic characteristics of patients were obtained via retrospective chart review. Clinical and angiographic states were evaluated retrospectively using quantitative methods. The mean duration of clinical follow up was 141.4 ± 19.5 months. RESULTS A total of 247 EDAS procedures were performed in 145 patients, including 15 EDAS performed using the occipital artery as the donor vessel. The mortality rate was 0%, and the permanent morbidity rates were 1.2% per operation and 2.0% per person. The mean modified Rankin Scale score was 1.21 ± 1.31 postoperatively and 1.01 ± 1.39 at the last follow-up. Of the 109 hemispheres studied, 45% were classified as grade A, 34% as grade B, and 21% as grade C collateral circulation. The annual rates of stroke were calculated to be 0.73% per person-year. Overall, the 1-,5-, and 10-year actuarial stroke rates were 2.1±1.2%, 6.8±2.1%, and 8.9±2.4%, respectively. Bilateral involvement was a common significant factor in any, hemorrhagic, and ischemic strokes. Hypertension was a risk factor for ischemic strokes during follow-up. CONCLUSIONS EDAS is an effective procedure in a Chinese cohort of patients with MMD. EDAS resulted in satisfactory long-term improvement of clinical states and prevention of recurrent strokes.
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Affiliation(s)
- Xiang-Yang Bao
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China
| | - Yong Zhang
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China; Department of Neurosurgery, 307th Hospital of People's Liberation Army, 307 Clinical College, Anhui Medical University, Beijing, China
| | - Qian-Nan Wang
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China
| | - Qian Zhang
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China
| | - Hui- Wang
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China
| | - Zheng-Shan Zhang
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China
| | - De-Sheng Li
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China
| | - Lian Duan
- Department of Neurosurgery, 307th Hospital of People's Liberation Army, Center for Cerebral Vascular Disease, Beijing, China.
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Patil VA, Kulkarni SD, Deopujari CE, Biyani NK, Udwadia-Hegde AH, Shah KN. Moyamoya Vasculopathy in Indian Children: Our Experience. J Pediatr Neurosci 2018; 12:320-327. [PMID: 29675069 PMCID: PMC5890550 DOI: 10.4103/jpn.jpn_65_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Moyamoya vasculopathy is a chronic progressive vaso-occlusive disease affecting the distal intracranial carotid arteries and their proximal branches. It is an important cause of recurrent strokes in children. Surgical revascularization procedures are now considered as the treatment option for moyamoya vasculopathy. The data from Indian children with moyamoya vasculopathy are limited to a very few studies. Study Design: We analyzed the records of children with moyamoya vasculopathy treated at our tertiary care center from 2000 to 2014. Our study population included all patients (aged 0–18 years) with moyamoya disease/syndrome (MMD/MMS). The demographic data, clinical characteristics, imaging, treatment details, and surgical procedures performed were reviewed. Results: A total of 41 patients (females-19, males-22) were identified. Thirty-three (80.48%) had MMD and eight (19.5%) had MMS. The mean age (±standard deviation) at presentation was 6.26 ± 3.79 years (range: 6 months–14 years). Majority had ischemic events at onset; none had hemorrhagic manifestations. Twenty-eight (68.29%) patients underwent surgery (a total of 33 surgical procedures, bilateral in five and unilateral in 23) and 13 (31.7%) were managed conservatively. The median duration of follow-up was 2.2 ± 1.85 years (range: 4 months–7 years). Two/thirteen patients (15%), who were managed conservatively, had recurrent strokes as against none (0/28) in the operated patients. No mortality was observed in our cohort. Conclusion: We agree with previous studies that Indian patients with moyamoya vasculopathy differ from their Asian and European counterparts. The availability of expertise in revascularization surgeries in various centers should prompt surgery as an efficient and safe treatment option.
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Affiliation(s)
- Varsha Anant Patil
- Department of Pediatric Neurosciences, Bai Jerbai Wadia Hospital, Mumbai, Maharashtra, India
| | | | | | - Naresh K Biyani
- Department of Pediatric Neurosciences, Bai Jerbai Wadia Hospital, Mumbai, Maharashtra, India
| | - Anaita H Udwadia-Hegde
- Department of Pediatric Neurosciences, Bai Jerbai Wadia Hospital, Mumbai, Maharashtra, India
| | - Krishnakumar N Shah
- Department of Pediatric Neurosciences, Bai Jerbai Wadia Hospital, Mumbai, Maharashtra, India
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91
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Clinical Features, Surgical Treatment, and Long-Term Outcome in Children with Hemorrhagic Moyamoya Disease. J Stroke Cerebrovasc Dis 2018; 27:1517-1523. [PMID: 29567119 DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/18/2017] [Accepted: 12/26/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The objective of this study was to elucidate the clinical features, surgical treatment, and long-term outcome in pediatric patients with moyamoya disease (MMD). METHODS We retrospectively reviewed 46 pediatric patients with hemorrhagic MMD at Beijing Tiantan Hospital. Clinical features, radiological findings, and outcomes were analyzed. RESULTS The mean age at diagnosis was 13.6 ± 3.6 years. The ratio of girls to boys was 1.0:1.1. Familial occurrence was 4.3%. The primary symptoms at initial presentation were intraventricular hemorrhage (IVH) (47.8%), intracerebral hemorrhage (ICH) (37.0%), ICH with IVH (13.0%), and subarachnoid hemorrhage (2.2%). Most patients presented with Suzuki stage 3 or 4 MMD. Posterior cerebral artery involvement was observed in 22 (18.4%) patients. During the average follow-up of 126.1 ± 96.0 months, 11 of 53 (20.8%) conservatively treated hemispheres and 1 of 36 (2.8%) surgically treated hemispheres experienced a stroke event (P < .05). There was a difference in the Kaplan-Meier curve of stroke between the 2 groups (log rank test, P < .05). What is more, the rate of perfusion improvement in surgically treated patients was higher than in those conservatively treated patients 3 months after discharge (P < .05). CONCLUSIONS Revascularization surgery has a role in the prevention of recurrent strokes and can improve cerebral perfusion in pediatric patients with hemorrhagic MMD. Further study is needed to determine which bypass surgery is more beneficial for pediatric patients with hemorrhagic MMD.
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93
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Blauwblomme T, Mathon B, Naggara O, Kossorotoff M, Bourgeois M, Puget S, Meyer P, Brousse V, de Montalembert M, Brunelle F, Zerah M, Sainte-Rose C. Long-term Outcome After Multiple Burr Hole Surgery in Children With Moyamoya Angiopathy: A Single-Center Experience in 108 Hemispheres. Neurosurgery 2018; 80:950-956. [PMID: 28327981 DOI: 10.1093/neuros/nyw161] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 12/22/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Multiple burr hole (MBH) surgery is a simple, safe, and effective indirect technique of revascularization in moyamoya angiopathy (MM). However, it is not yet recognized as a first-line treatment. OBJECTIVE To assess the long-term outcome and perioperative complications in a large single-center cohort of children with MM who underwent burr hole surgery. METHODS This study is a retrospective analysis of children who underwent surgery for MM in a national reference center for pediatric stroke between 1999 and 2015. Sixty-four children (108 hemispheres, median age 7 years) were consecutively treated. The indication for revascularization was previous stroke or transient ischemic attack (TIA) or rapidly progressive disease on brain magnetic resonance imaging (MRI) and digital subtraction angiography. Children were followed with clinical examinations, telephone interviews, and MRI with any clinical recurrence of stroke or TIA used as the primary endpoint. Surgical mortality and morbidity were documented. RESULTS Sixty-four patients were operated (bilateral MBH n = 39, unilateral procedure n = 25). At a mean follow-up of 4.2 years and 270.6 patient years, 89.1% of patients had not suffered any recurrent stroke or TIA. A second surgery was required in 5 cases after unilateral revascularization, and in 3 cases after bilateral MBH. Mortality associated with the procedure was 0. Postoperative Matsushima angiographic grading was the only predictive factor of ischemic recurrence ( P = .036). CONCLUSION In pediatric MM, MBH compares favorably to other indirect or direct revascularization techniques in children in the prevention of stroke or TIA.
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Affiliation(s)
- Thomas Blauwblomme
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France
| | | | - Olivier Naggara
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,INSERM U894, Department of Neuroradiology, Sainte-Anne Hospital, Paris, France.,APHP, Department of Pediatric Neurology, French Center for Pediatric Stroke, Necker Hospital, Paris, France
| | - Manoelle Kossorotoff
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurology, French Center for Pediatric Stroke, Necker Hospital, Paris, France.,APHP, Department of Anesthesiology, Necker Hospital, Paris, France
| | - Marie Bourgeois
- APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France
| | - Stéphanie Puget
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France
| | - Philippe Meyer
- APHP, Department of Anesthesiology, Necker Hospital, Paris, France
| | - Valentine Brousse
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,Reference Centre for Sickle Cell Disease, Necker Hospital, Paris, France
| | - Marianne de Montalembert
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,Reference Centre for Sickle Cell Disease, Necker Hospital, Paris, France
| | - Francis Brunelle
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Neuroradiology, Necker Hospital, Paris, France
| | - Michel Zerah
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France.,French National Reference Centre for Pediatric Stroke, Paris, France
| | - Christian Sainte-Rose
- Université René Descartes, PRES Sorbonne Paris Cité, Paris, France.,APHP, Department of Pediatric Neurosurgery, Necker Hospital, Paris, France
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TOMINAGA T, SUZUKI N, MIYAMOTO S, KOIZUMI A, KURODA S, TAKAHASHI JC, FUJIMURA M, HOUKIN K. Recommendations for the Management of Moyamoya Disease: A Statement from Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) [2nd Edition]. ACTA ACUST UNITED AC 2018. [DOI: 10.2335/scs.46.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Teiji TOMINAGA
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Norihiro SUZUKI
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Susumu MIYAMOTO
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Akio KOIZUMI
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Satoshi KURODA
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Jun C. TAKAHASHI
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Miki FUJIMURA
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
| | - Kiyohiro HOUKIN
- On behalf of the Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) Research on Intractable Diseases of the Ministry of Health, Labour and Welfare
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95
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Duan L, Wei L, Tian Y, Zhang Z, Hu P, Wei Q, Liu S, Zhang J, Wang Y, Li D, Yang W, Zong R, Xian P, Han C, Bao X, Zhao F, Feng J, Liu W, Cao W, Zhou G, Zhu C, Yu F, Yang W, Meng Y, Wang J, Chen X, Wang Y, Shen B, Zhao B, Wan J, Zhang F, Zhao G, Xu A, Zhang X, Liu J, Zuo X, Wang K. Novel Susceptibility Loci for Moyamoya Disease Revealed by a Genome-Wide Association Study. Stroke 2018; 49:11-18. [PMID: 29273593 DOI: 10.1161/strokeaha.117.017430] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 10/23/2017] [Accepted: 11/13/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Moyamoya disease (MMD) is a rare cerebral vasculopathy characterized by bilateral internal carotid artery stenosis and often leads to stroke in children or young adults. Although familial inheritance is well recognized, the genetic basis of MMD remains poorly understood.
Methods—
A 2-stage genome-wide association study was conducted involving 1492 cases and 5084 controls. In the discovery stage, logistic regression was used to test associations, and imputation was conducted based on genotyped single-nucleotide polymorphisms (SNPs). In the validation stage, the top significant SNPs were again genotyped in an independent cohort. Fixed-effects inverse variance-weighted meta-analysis was used in the combined discovery and validation samples. Furthermore, association analysis was conducted in subgroups using patient clinical data.
Results—
The study identified 10 novel risk loci with genome-wide significance (
P
<5×10
−8
) and confirmed a previously reported locus on 17q25. No significant SNP showed evidence of heterogeneity between the 2 stages. Cumulatively, these SNPs explained 14.76% of disease risk variance—a substantial proportion of the 39.02% of risk variance explained by all genome-wide genotyped SNPs. One SNP, rs9916351 in
RNF213
(
P
combined
=4.57×10
−54
; odds ratio, 1.96), showed a stronger genetic effect on early-onset than late-onset MMD (
P
=0.003). Two novel SNPs in genes regulating homocysteine metabolism, rs9651118 in
MTHFR
(
P
combined
=2.49×10
−19
; odds ratio, 0.65) and rs117353193 in
TCN2
(
P
combined
=6.15×10
−13
; odds ratio, 1.43), were associated with high-serum homocysteine in MMD cases. Additionally, another SNP associated with MMD (rs2107595 in
HDAC9
;
P
combined
=1.49×10
−29
; odds ratio, 1.64) was previously implicated in large-vessel disease. Tissue enrichment analysis showed that the genes of associated loci were highly expressed in the immune system (false discovery rate, <0.05).
Conclusions—
This study identifies several novel susceptibility genes for MMD. The association with homocysteine metabolism and the immune system enrichment of susceptibility gene expression suggest that therapeutic interventions targeting these pathways may be effective approaches for MMD treatment.
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Affiliation(s)
- Lian Duan
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Ling Wei
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Yanghua Tian
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Zhengshan Zhang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Panpan Hu
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Qiang Wei
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Sugang Liu
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Jun Zhang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Yuyang Wang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Desheng Li
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Weizhong Yang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Rui Zong
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Peng Xian
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Cong Han
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Xiangyang Bao
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Feng Zhao
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Jie Feng
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Wei Liu
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Wuchun Cao
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Guoping Zhou
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Chunyan Zhu
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Fengqiong Yu
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Weimin Yang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Yu Meng
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Jingye Wang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Xianwen Chen
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Yu Wang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Bing Shen
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Bing Zhao
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Jinghai Wan
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Fengyu Zhang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Gang Zhao
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Aimin Xu
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Xuejun Zhang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Jianjun Liu
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Xianbo Zuo
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
| | - Kai Wang
- From the Department of Neurosurgery, 307 Hospital, PLA Center for Cerebral Vascular Disease, Clinical Colleague of Anhui Medical University, Beijing, China (L.D., Z.Z., S.L., D.L., W.Y., R.Z., P.X., C.H., X.B., F.Z., J.F.); Department of Neurology (L.W., Y.T., P.H., Q.W., J.Z., W.Y., Y.M., J.W., X.C., Y.W., K.W.) and Department of Dermatology (F.Z., X. Zhang, X. Zuo), First Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurosurgery, Second Affiliated Hospital of Anhui
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Neurologic Deterioration in Patients with Moyamoya Disease during Pregnancy, Delivery, and Puerperium. World Neurosurg 2017; 111:e7-e17. [PMID: 29180090 DOI: 10.1016/j.wneu.2017.11.094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/17/2017] [Accepted: 11/18/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND We reviewed our clinical experience of patients with moyamoya disease (MMD) who gave birth and assessed characteristics of those experiencing neurologic deterioration. METHODS The patients were classified into patients diagnosed with MMD during pregnancy and puerperium (group 1) and those diagnosed before pregnancy (group 2). We retrospectively reviewed patient characteristics, MMD treatment, neurologic symptoms before and during pregnancy and/after puerperium, obstetrical history, and delivery type in groups 1 and 2. RESULTS Group 1 included 2 patients with deterioration of pre-existing transient ischemic attacks (TIAs) and acute cerebral infarction and 1 patient with seizures and newly developed TIAs during pregnancy and/or puerperium. Group 2 included 20 patients with 23 pregnancies. In group 2, 4 patients had deterioration of TIAs during pregnancy and puerperium. There were significant differences between the cases without neurologic deterioration and with deterioration in group 2 (TIAs ≥10 before pregnancy, 0% vs. 75%, P = 0.002; severely reduced regional cerebrovascular reserve on single-photon emission computed tomography, 10.5% vs. 100%, P = 0.002; and surgical revascularization before pregnancy, 75% vs. 15.8%, P = 0.04). In groups 1 and 2, 6 of the 7 cases in which TIAs occurred or worsened during pregnancy or puerperium recovered to prepregnancy TIA levels after puerperium. CONCLUSIONS Patients with severely reduced regional cerebrovascular reserve on single-photon emission computed tomography and frequent TIAs before pregnancy may experience neurologic deterioration during pregnancy, delivery, and puerperium. Surgical revascularization before pregnancy may decrease neurologic deterioration during these periods.
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Ma Y, Zhao M, Zhang Q, Liu X, Zhang D, Wang S, Zhang Y, Li M, Zhao J. Risk Factors for Epilepsy Recurrence after Revascularization in Pediatric Patients with Moyamoya Disease. J Stroke Cerebrovasc Dis 2017; 27:740-746. [PMID: 29128331 DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/30/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE We aimed to explore the risk factors of seizure recurrence and the optimal surgical procedure for epileptic pediatric patients with moyamoya disease (MMD). METHODS We reviewed 696 consecutive patients with MMD admitted to our hospital from 2009 to 2015. Pediatric patients with MMD who had seizures before revascularization were identified. We summarized the characteristics of seizures in pediatric patients with MMD and analyzed the predictive factors of recurrent seizure events. RESULTS We identified 28 pediatric patients with MMD who had seizures before revascularization. During follow-up (median 42 months), 7 patients (25.0%) experienced recurrent seizures. In the multivariate analysis, the duration of epilepsy was an independent predictor for postoperative seizure recurrences (odds ratio 3.84, 95% confidence interval 1.54-24.34; P = .035). The 2 common surgical modalities of MMD (direct and indirect bypass) had no significant difference in future seizure prevention in pediatric patients with MMD with epilepsy. CONCLUSIONS We identified the duration of epilepsy as an independent risk factor for recurrent seizure after revascularization in pediatric patients with MMD.
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Affiliation(s)
- Yonggang Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Qian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Xingju Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Maogui Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.
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Chong S, Park JD, Chae JH, Cheon JE, Kim SK, Phi JH, Lee JY, Paeng JC, Wang KC. Extensive brain infarction involving deep structures during an acetazolamide-challenged single-photon emission computed tomography scan in a patient with moyamoya disease. Childs Nerv Syst 2017; 33:2029-2033. [PMID: 28689345 DOI: 10.1007/s00381-017-3512-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/27/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Acetazolamide-challenged brain single-photon emission computed tomography (SPECT) is used for the evaluation of cerebral perfusion in cerebrovascular diseases including moyamoya disease (MMD). Not a few patients experience adverse side effects during the acetazolamide-challenged brain SPECT, but most of the symptoms are mild and transient. To our knowledge, this is the first case report of severe brain infarction leading to death during the examination of an acetazolamide-challenged brain SPECT in a patient with MMD. CASE PRESENTATION An 11-year-old girl who had been diagnosed of MMD demonstrated sudden tonic movement during an acetazolamide-challenged brain SPECT as the preoperative examination for the second surgery. She had not experienced any adverse effect during the previous SPECT study and her first indirect bypass surgery on both left side and bifrontal area was uneventful. After she had seizures twice, she became unconscious and her pupils were dilated and fixed. Acute infarction involving bilateral occipital lobes, thalami, brainstem, and cerebellum was observed on brain magnetic resonance images which led to brain death. CONCLUSION We report a mortality case of patient with MMD after the administration of acetazolamide during the examination of brain SPECT that was accompanied by an extensive acute infarction involving the bilateral occipital lobes and thalami, brainstem, and cerebellum. Physicians should be aware of this rare but serious complication.
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Affiliation(s)
- Sangjoon Chong
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jong Hee Chae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jung-Eun Cheon
- Division of Pediatric Radiology, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Anatomy, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Kyu-Chang Wang
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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99
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Zhao M, Zhang D, Wang S, Zhang Y, Wang R, Deng X, Gao F, Zhao J. Adolescents with moyamoya disease: clinical features, surgical treatment and long-term outcomes. Acta Neurochir (Wien) 2017; 159:2071-2080. [PMID: 28791519 DOI: 10.1007/s00701-017-3286-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/19/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aimed to elucidate the clinical features, surgical treatment and long-term outcomes of adolescent patients with moyamoya disease. METHODS We reviewed consecutive patients with moyamoya vasculopathy who were admitted to our hospital from 2009 to 2015 to identify adolescent patients with moyamoya disease. Clinical features, surgical treatment and long-term outcomes were analyzed. Follow-up was performed by face-to-face or structured telephone interviews. Outcome measures were future stroke events. We performed univariate and multivariate time-to-event analyses to identify risk factors associated with future stroke events. RESULTS A total of 95 adolescent patients with moyamoya disease (age at onset, 13.1 ± 2.3 years) were included in this study. During follow-up, 12 patients (12.6%) had stroke events. We found that the patients who underwent direct/combined bypass had a significantly lower risk of future strokes [hazard ratio (HR), 0.16; 95% confidence interval (CI), 0.03-0.74; P = 0.019] compared to patients who underwent indirect bypass. CONCLUSIONS Our results demonstrate that direct/combined bypass can be more effective in preventing future strokes than indirect bypass in adolescent patients with moyamoya disease.
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Affiliation(s)
- Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Faliang Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, People's Republic of China, 100050.
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.
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Zhao M, Deng X, Wang S, Zhang D, Zhang Y, Zhao J. Lacunar infarction in adult patients with moyamoya disease. Clin Neurol Neurosurg 2017; 164:81-86. [PMID: 29202378 DOI: 10.1016/j.clineuro.2017.10.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/03/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Lacunar infarctions in moyamoya disease have rarely been described. We aimed to evaluate the features and prognosis of adult moyamoya patients with lacunar infarction. PATIENTS AND METHODS We reviewed 696 consecutive moyamoya patients admitted to our hospital from 2009 to 2015 to identify patients with lacunar infarctions. We compared the clinical features and prognosis of adult moyamoya patients with lacunar infarction and those with non-lacunar infarction. Follow-up was conducted by face-to-face reviews or by a structured telephone interview. Outcome measures were recurrent stroke events and functional outcomes by modified Rankin Scale (mRS). RESULTS We identified 32 patients with lacunar infarction among 197 adult moyamoya disease patients with infarctions. Patients with lacunar infarctions demonstrated similar angiographic features with patients with non-lacunar infarctions. During a mean follow-up of 33.02±20.49months, we observed recurrent stroke events in 1 patients with lacunar infarction and 14 patients with non-lacunar infarction. The mean follow-up mRS was significantly better in the lacunar group than in the non-lacunar group (0.59±0.56 vs. 1.13±1.24; P<0.001). CONCLUSION We identified that the moyamoya patients with lacunar infarctions had better functional outcomes comparing with patients with non-lacunar infarction after revascularization.
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Affiliation(s)
- Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China
| | - Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China.
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