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Guo Q, Fan YN, Wang QN, Li J, Han C, Zou Z, Liu S, Wang X, Yu D, Hao F, Gao G, Zhang Q, Pei S, Feng J, Yang R, Wang M, Fu H, Bao X, Duan L. Nomogram for Predicting Long-term Outcomes of Encephaloduroarteriosynangiosis in Toddlers with Moyamoya Disease: a Longitudinal and Cross-sectional Study. Transl Stroke Res 2023:10.1007/s12975-023-01213-w. [PMID: 37943490 DOI: 10.1007/s12975-023-01213-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
We investigated the long-term outcomes of encephaloduroarteriosynangiosis (EDAS) for stroke prevention in toddlers with moyamoya disease (MMD) using nomogram. Between January 2005 and December 2018, 74 toddlers with MMD underwent surgery in the Fifth Medical Centre, Chinese PLA General Hospital, 69 were < 4 years of age and included in the analysis. The modified Rankin scale (mRS) during follow-up evaluated clinical outcomes. To measure the effectiveness of EDAS, the annual risk of symptomatic infarction within the operated brain hemispheres was calculated. The event-free survival rate was determined using Kaplan-Meier curves. A nomogram generated using multivariate logistic regression analysis identified potential predictors associated with unfavorable outcomes. Additionally, discrimination, calibration, and clinical utility were assessed. A favorable clinical outcome was observed in 81.2% of the patients. The operated hemispheres showed an annual risk of 0.87% of symptomatic infarction and 0.23% of hemorrhage. Moreover, the 10-year event-free survival rates were 92.8% and 97.0% for symptomatic infarction and hemorrhage. Multivariate logistic analysis indicated that onset with infarction, initial mRS ≥ 3, and perioperative adverse events had significant and independent associations with unfavorable outcomes. However, an age at diagnosis of ≥ 2 years showed an association with favorable outcomes. Using these four factors, our model attained a concordance index of 0.912 (95% confidence interval, 0.842-0.982), well-fitted calibration curve, and cutoff value of 0.212 for predicting unfavorable outcomes. EDAS may prevent recurrent stroke and improve overall long-term clinical outcomes in toddlers with MMD. The developed nomogram accurately predicted unfavorable outcomes and assisted surgeons in patient evaluation.
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Affiliation(s)
- Qingbao Guo
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Yan-Na Fan
- Department of Radiation Oncology, Senior Department of Oncology, the Fifth Medical Center of, PLA General Hospital, Beijing, China
| | - Qian-Nan Wang
- Department of Neurosurgery, the Eighth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jingjie Li
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Cong Han
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhengxing Zou
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Simeng Liu
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Xiaopeng Wang
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Dan Yu
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Fangbin Hao
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Gan Gao
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Qian Zhang
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Songtao Pei
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jie Feng
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Rimiao Yang
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Minjie Wang
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Heguan Fu
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xiangyang Bao
- Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China.
| | - Lian Duan
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.
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Lehman LL, Ullrich NJ. Cerebral Vasculopathy in Children with Neurofibromatosis Type 1. Cancers (Basel) 2023; 15:5111. [PMID: 37894478 PMCID: PMC10605225 DOI: 10.3390/cancers15205111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Cerebrovascular abnormalities are a severe and often underrecognized complication of childhood neurofibromatosis type 1 (NF1). There are no prospective studies of cerebral vasculopathy in NF1; thus, the estimated frequency of vasculopathy varies between studies. The data is difficult to interpret due to the retrospective data collection and variability in whether imaging is done based on screening/surveillance or due to acute neurologic symptoms. The prevalent NF1-associated cerebral vasculopathy is moyamoya syndrome (MMS). Vascular changes can present without symptoms or with acute TIA or stroke-like symptoms or a range of progressive neurologic deficits. Advanced imaging may enhance sensitivity of neuroimaging in children. Medical and/or surgical interventions may prevent short- and long-term complications. Challenges for establishment of a screening protocol for cerebral vasculopathy in children with NF1 include the relatively large number of patients with NF1, the potential need for sedation to achieve quality imaging and the broad age range at time of detection for cerebral vascular changes. The goal of this review is to present the epidemiology, clinical presentation, imaging features and medical/surgical management of cerebral arteriopathies in children with NF1.
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Affiliation(s)
- Laura L Lehman
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Gonzalez NR, Amin-Hanjani S, Bang OY, Coffey C, Du R, Fierstra J, Fraser JF, Kuroda S, Tietjen GE, Yaghi S. Adult Moyamoya Disease and Syndrome: Current Perspectives and Future Directions: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2023; 54:e465-e479. [PMID: 37609846 DOI: 10.1161/str.0000000000000443] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Adult moyamoya disease and syndrome are rare disorders with significant morbidity and mortality. A writing group of experts was selected to conduct a literature search, summarize the current knowledge on the topic, and provide a road map for future investigation. The document presents an update in the definitions of moyamoya disease and syndrome, modern methods for diagnosis, and updated information on pathophysiology, epidemiology, and both medical and surgical treatment. Despite recent advancements, there are still many unresolved questions about moyamoya disease and syndrome, including lack of unified diagnostic criteria, reliable biomarkers, better understanding of the underlying pathophysiology, and stronger evidence for treatment guidelines. To advance progress in this area, it is crucial to acknowledge the limitations and weaknesses of current studies and explore new approaches, which are outlined in this scientific statement for future research strategies.
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Kuroda S, Yamamoto S, Funaki T, Fujimura M, Kataoka H, Hishikawa T, Takahashi J, Endo H, Nariai T, Osato T, Saito N, Sato N, Hori E, Ito YM, Miyamoto S. Five-Year Stroke Risk and Its Predictors in Asymptomatic Moyamoya Disease: Asymptomatic Moyamoya Registry (AMORE). Stroke 2023; 54:1494-1504. [PMID: 37216455 DOI: 10.1161/strokeaha.122.041932] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/30/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Long-term outcomes are unknown in patients with asymptomatic moyamoya disease. In this report, we aimed to clarify their 5-year risk of stroke and its predictors. METHODS We are conducting a multicenter, prospective cohort study (Asymptomatic Moyamoya Registry) in Japan. Participants were eligible if they were 20 to 70 years, had bilateral or unilateral moyamoya disease, experienced no episodes suggestive of TIA and stroke; and were functionally independent (modified Rankin Scale score 0-1). Demographic and radiological information was collected at enrollment. In this study, they are still followed up for 10 years. In this interim analysis, we defined the primary end point as a stroke occurring during a 5-year follow-up period. Independent predictors for stroke were also determined, using a stratification analysis method. RESULTS Between 2012 and 2015, we enrolled 109 patients, of whom 103 patients with 182 involved hemispheres completed the 5-year follow-up. According to the findings on DSA and MRA, 143 hemispheres were judged as moyamoya disease and 39 hemispheres as questionable manifestations (isolated middle cerebral artery stenosis). The patients with questionable hemispheres were significantly older, more often male, and more frequently had hypertension than those with moyamoya hemisphere. Moyamoya hemispheres developed 7 strokes, including 6 hemorrhagic and 1 ischemic stroke, during the first 5 years. The annual risk of stroke was 1.4% per person, 0.8% per hemisphere, and 1.0% per moyamoya hemisphere. Independent predictor for stroke was Grade-2 choroidal anastomosis (hazard ratio, 5.05 [95% CI, 1.24-20.6]; P=0.023). Furthermore, microbleeds (hazard ratio, 4.89 [95% CI, 1.13-21.3]; P=0.0342) and Grade-2 choroidal anastomosis (hazard ratio, 7.05 [95% CI, 1.62-30.7]; P=0.0093) significantly predicted hemorrhagic stroke. No questionable hemispheres developed any stroke. CONCLUSIONS The hemispheres with asymptomatic moyamoya disease may carry a 1.0% annual risk of stroke during the first 5 years, the majority of which are hemorrhagic stroke. Grade-2 choroidal anastomosis may predict stroke, and the microbleeds and Grade-2 choroidal anastomosis may carry the risk for hemorrhagic stroke. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: UMIN000006640.
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Affiliation(s)
- Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan (S.K., S.Y., E.H.)
| | - Shusuke Yamamoto
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan (S.K., S.Y., E.H.)
| | - Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (T.F., S.M.)
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan (M.F.)
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan (H.K.)
| | - Tomohito Hishikawa
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Japan (T.H.)
| | - Jun Takahashi
- Department of Neurosurgery, Kindai University School of Medicine, Sayama, Japan (J.T.)
| | - Hidenori Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan (H.E.)
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Japan (T.N.)
| | - Toshiaki Osato
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan (T.O.)
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Japan (N. Saito)
| | - Norihiro Sato
- Clinical Research and Medical Innovation Center (N. Sato), Hokkaido University Hospital, Sapporo, Japan
| | - Emiko Hori
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan (S.K., S.Y., E.H.)
| | - Yoichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care (Y.M.I.), Hokkaido University Hospital, Sapporo, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan (T.F., S.M.)
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Fujioka M, Hara S, Mukawa M, Karakama J, Inaji M, Tanaka Y, Nariai T, Maehara T. Changes in the clinical spectrum of pediatric moyamoya disease over 40 years. Childs Nerv Syst 2023; 39:1215-1223. [PMID: 36790492 DOI: 10.1007/s00381-023-05852-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/14/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To investigate the chronological changes in the clinical presentation and long-term prognosis of pediatric-onset moyamoya disease in our institute over 40 years. METHODS We evaluated 282 pediatric-onset (≤ 15 years old) moyamoya disease patients who visited our institute from 1981 to 2020 (divided into the former period, 1981-2000, and the latter period, 2001-2020). Differences in the clinical presentation and the long-term outcome were compared between the periods. Multivariate analysis was also performed to reveal the risk factors for poor long-term outcomes. RESULTS Compared to the former period, the total number of patients, the onset age and both the number of patients with family history and relatively older patients without symptoms or with headache were greater in the latter period (p < 0.05). The number of patients with poor long-term outcomes was significantly lower in the latter period (24.9% vs. 6.7%, p < 0.01). Multivariate analysis revealed that stroke onset, late cerebrovascular events and postoperative complications were independent risk factors for poor long-term outcomes (odds ratio = 31.4, 40.8 and 5.4, respectively). CONCLUSIONS Over the last 40 years, the number of pediatric moyamoya disease patients has increased, especially in relatively older patients with mild presentation and favorable long-term outcomes. In clinical studies, these chronological changes and the inclusion period of the participants need to be accounted for. Whether the increased diagnostic rate in the recent era has led to a decrease in late cerebrovascular events and favorable outcomes throughout life remains unknown and should be evaluated in the future.
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Affiliation(s)
- Mai Fujioka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Maki Mukawa
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Karakama
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
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Hirano Y, Miyawaki S, Imai H, Hongo H, Teranishi Y, Ishigami D, Sakai Y, Shimada D, Umekawa M, Segawa M, Koizumi S, Ono H, Nakatomi H, Saito N. Clinical and Genetic Characteristics of Patients with Moyamoya Disease who Experienced Both Ischemic and Hemorrhagic Events. World Neurosurg 2023; 172:e438-e446. [PMID: 36657715 DOI: 10.1016/j.wneu.2023.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Cerebrovascular events in moyamoya disease are mainly classified into ischemic or hemorrhagic onset. It is rare for one patient to develop both ischemia and hemorrhage in moyamoya disease; detailed clinical course and genetic characteristics of such patients have not been elucidated. We aimed to clarify the clinical features of patients with both ischemic and hemorrhagic cerebrovascular events. METHODS We analyzed the background factors, radiological features, and genotype of ring finger protein 213 c.14429 G > A (p.Arg4810Lys) of patients with moyamoya disease who visited our hospital between 1996 and 2020, and experienced both ischemic and hemorrhagic cerebrovascular events. Additionally, we analyzed factors that caused subsequent hemorrhage in adult-onset ischemic moyamoya disease. RESULTS Of 262 patients, 12 presented with both ischemia and hemorrhage, of which, 4 exhibited pediatric onset and 8 had adult onset. In pediatric-onset subjects, ischemia was the initial event in all cases. Hemorrhagic events occurred at a median of 24.7 years postoperatively in patients who had undergone bypass surgery. In adult-onset subjects, ischemia preceded hemorrhage in 7 patients. In males, the interval to subsequent hemorrhage was significantly shorter for adult-onset ischemic moyamoya disease, and the hazard ratio for hemorrhagic events was 5.45. The ring finger protein 213 p.Arg4810Lys heterozygous variant was present in 9 patients. CONCLUSIONS A majority of patients with moyamoya disease with both ischemia and hemorrhage experience an ischemic event first. Patients who developed ischemia in childhood may develop subsequent hemorrhage in approximately 20-25 years after bypass surgery. Male sex is a risk factor for a subsequent hemorrhagic event in adult-onset ischemic moyamoya disease.
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Affiliation(s)
- Yudai Hirano
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hideaki Imai
- Department of Neurosurgery, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Shinjuku-ku, Tokyo, Japan
| | - Hiroki Hongo
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yu Teranishi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Daiichiro Ishigami
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yu Sakai
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Daisuke Shimada
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Motoyuki Umekawa
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masafumi Segawa
- Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa-Ku, Tokyo, Japan
| | - Satoshi Koizumi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hideaki Ono
- Department of Neurosurgery, Fuji Brain Institute and Hospital Fujinomiya, Shizuoka, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Angioarchitectural Factors Associated with Postoperative Cerebral Infarction in Ischemic Moyamoya Disease. Brain Sci 2022; 12:brainsci12101270. [PMID: 36291204 PMCID: PMC9599360 DOI: 10.3390/brainsci12101270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: To investigate the angioarchitectural factors associated with postoperative cerebral infarction in ischemic moyamoya disease. Methods: Data on patients who underwent surgery for ischemic MMD from 1 October 2015 to 31 October 2020, at Peking University International Hospital were collected and retrospectively analyzed. General conditions such as patient sex, age, site of surgery, preoperative manifestations such as TIA attack and old cerebral infarction, and seven angioarchitectural factors of the MMD based on DSA were selected and measured. Statistical analysis was performed by the Pearson chi-square statistic, analysis of variance (ANOVA), and multifactor logistic regression analysis. Results: Age (OR, 0.969; 95%CI, 0.939–1.000; p = 0.049), A1stenosis (OR, 5.843; 95%CI, 1.730–19.732; p = 0.004), M1stenosis (OR, 6.206; 95%CI, 2.079–18.526; p = 0.001), PCA anomalies (OR, 4.367; 95%CI, 1.452–13.129; p = 0.049), Unstable compensation (OR, 5.335; 95%CI, 1.427–19.948; p = 0.013), TIA (OR, 4.264; 95%CI, 1.844–9.863; p = 0.001), Old cerebral infarction (OR, 2.972; 95%CI, 1.194–7.397; p = 0.019). The above seven factors can be used in the regression equation to predict the probability of postoperative cerebral infarction. The prediction accuracy is 90.2%. Conclusions: Age, TIA attack, old cerebral infarction, and five angioarchitectural factors of MMD are strongly associated with postoperative cerebral infarction. Seven factors, including age, TIA attack, old infarction, and four angioarchitectural factors, can be taken to quantify the probability of surgical cerebral infarction in MMD.
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Gao T, Zou C, Li J, Han C, Zhang H, Li Y, Tang X, Fan Y. Identification of moyamoya disease based on cerebral oxygen saturation signals using machine learning methods. JOURNAL OF BIOPHOTONICS 2022; 15:e202100388. [PMID: 35102703 DOI: 10.1002/jbio.202100388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
Moyamoya is a cerebrovascular disease with a high mortality rate. Early detection and mechanistic studies are necessary. Near-infrared spectroscopy (NIRS) was used to study the signals of the cerebral tissue oxygen saturation index (TOI) and the changes in oxygenated and deoxygenated hemoglobin concentrations (HbO and Hb) in 64 patients with moyamoya disease and 64 healthy volunteers. The wavelet transforms (WT) of TOI, HbO and Hb signals, as well as the wavelet phase coherence (WPCO) of these signals from the left and right frontal lobes of the same subject, were calculated. Features were extracted from the spontaneous oscillations of TOI, HbO and Hb in five physiological activity-related frequency segments. Machine learning models based on support vector machine (SVM), random forest (RF) and extreme gradient boosting (XGBoost) have been built to classify the two groups. For 20-min signals, the 10-fold cross-validation accuracies of SVM, RF and XGBoost were 87%, 85% and 85%, respectively. For 5-min signals, the accuracies of the three methods were 88%, 88% and 84%, respectively. The method proposed in this article has potential for detecting and screening moyamoya with high proficiency. Evaluating the cerebral oxygenation with NIRS shows great potential in screening moyamoya diseases.
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Affiliation(s)
- Tianxin Gao
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Chuyue Zou
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Jinyu Li
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Cong Han
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Houdi Zhang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Yue Li
- School of Medicine, Tsinghua University, Beijing, China
| | - Xiaoying Tang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Yingwei Fan
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
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Kusano Y, Funaki T, Ueda K, Nishida N, Tanaka K, Miyamoto S, Matsuda S. Characterizing the neurocognitive profiles of children with moyamoya disease using the Das Naglieri cognitive assessment system. Sci Rep 2022; 12:3638. [PMID: 35256691 PMCID: PMC8901907 DOI: 10.1038/s41598-022-07699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
Although cognitive impairment is well-documented in children with moyamoya disease (MMD), selective decline in specific neurocognitive domains remains controversial. The purpose of this study was to characterize the neurocognitive profile of children with MMD using the Das Naglieri Cognitive Assessment System (CAS) and the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV). We analyzed the neurocognitive data of 30 children (median age, 7 years) with MMD who were assessed with the CAS and the WISC-IV before surgery. We focused on the comparison of standard scores and intraindividual differences across domains. The CAS scores significantly varied across four measures (standard scores, p < 0.001; intraindividual differences, p < 0.001). Post-hoc analyses revealed that the standard scores and intraindividual differences for successive processing were significantly lower than those for planning and attention. The WISC-IV scores did not significantly vary among the four measures, although the working memory index was the lowest among the four measures. The within-individual weakness in successive processing, a form of working memory function, may be a distinct characteristic of children with MMD. The CAS may be more sensitive than the WISC-IV for detecting this selective neurocognitive weakness in children with MMD.
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Affiliation(s)
- Yusuke Kusano
- Advanced Occupational Therapy, Department of Human Health Sciences, Kyoto University Graduate School of Medicine, 53 Kawahara-cho Syogoin Sakyo-ku, Kyoto, Japan. .,Rehabilitation Unit, Kyoto University Hospital, 54 Kawahara-cho Syogoin Sakyo-ku, Kyoto, Japan.
| | - Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Keita Ueda
- Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Faculty of Health Sciences, Department of Medical Welfare, Kyoto Koka Women's University, Kyoto, Japan
| | - Noyuri Nishida
- Rehabilitation Unit, Kyoto University Hospital, 54 Kawahara-cho Syogoin Sakyo-ku, Kyoto, Japan
| | - Kanade Tanaka
- Rehabilitation Unit, Kyoto University Hospital, 54 Kawahara-cho Syogoin Sakyo-ku, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, 54 Kawahara-cho Syogoin Sakyo-ku, Kyoto, Japan.,Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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10
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Clinical Management of Moyamoya Patients. J Clin Med 2021; 10:jcm10163628. [PMID: 34441923 PMCID: PMC8397113 DOI: 10.3390/jcm10163628] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 01/01/2023] Open
Abstract
Moyamoya angiopathy (MMA) is a peculiar cerebrovascular condition characterized by progressive steno-occlusion of the terminal part of the internal carotid arteries (ICAs) and their proximal branches, associated with the development of a network of fragile collateral vessels at the base of the brain. The diagnosis is essentially made by radiological angiographic techniques. MMA is often idiopathic (moyamoya disease-MMD); conversely, it can be associated with acquired or hereditary conditions (moyamoya Syndrome-MMS); however, the pathophysiology underlying either MMD or MMS has not been fully elucidated to date, and this poor knowledge reflects uncertainties and heterogeneity in patient management. MMD and MMS also have similar clinical expressions, including, above all, ischemic and hemorrhagic strokes, then headaches, seizures, cognitive impairment, and movement disorders. The available treatment strategies are currently shared between idiopathic MMD and MMS, including pharmacological and surgical stroke prevention treatments and symptomatic drugs. No pharmacological treatment able to reverse the progressive disappearance of the ICAs has been found to date in both idiopathic and syndromic cases. Antithrombotic agents are usually prescribed in ischemic MMA, although the coexisting hemorrhagic risk should be considered. Surgical revascularization techniques, which are currently the best available treatment in symptomatic MMA, are associated with good long-term outcomes and reduced ischemic and hemorrhagic risks. Given the lack of dedicated randomized clinical trials, current treatment is mainly based on observational studies and physicians’ and surgeons’ expertise.
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Nakajima S, Fushimi Y, Funaki T, Okubo G, Sakata A, Hinoda T, Yokota Y, Oshima S, Otani S, Kikuchi T, Okada T, Yoshida K, Miyamoto S, Nakamoto Y. Quiet Diffusion-weighted MR Imaging of the Brain for Pediatric Patients with Moyamoya Disease. Magn Reson Med Sci 2021; 21:583-591. [PMID: 34334585 DOI: 10.2463/mrms.mp.2020-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Diffusion-weighted MRI (DWI) is an essential sequence for evaluating pediatric patients with moyamoya disease (MMD); however, acoustic noise associated with DWI may lead to motion artifact. Compared with conventional DWI (cDWI), quiet DWI (qDWI) is considered less noisy and able to keep children more relaxed and stable. This study aimed to evaluate the suitability of qDWI compared with cDWI for pediatric patients with MMD. METHODS In this observational study, MR examinations of the brain were performed either with or without sedation in pediatric patients with MMD between September 2017 and August 2018. Three neuroradiologists independently evaluated the images for artifacts and restricted diffusion in the brain. The differences between qDWI and cDWI were compared statistically using a chi-square test. RESULTS One-hundred and six MR scans of 56 patients with MMD (38 scans of 15 sedated patients: 6 boys and 9 girls; mean age, 5.2 years; range, 1-9 years; and 68 scans of 42 unsedated patients: 19 boys and 23 girls; mean age, 10.7 years; range, 7-16 years) were evaluated. MR examinations were performed either with or without sedation (except in one patient). In sedated patients, no artifact other than susceptibility was observed on qDWI, whereas four artifacts were observed on cDWI (P = .04). One patient awoke from sedation during cDWI scanning, while no patient awoke from sedation during qDWI acquisition. For unsedated patients, three scans showed artifacts on qDWI, whereas two scans showed artifacts on cDWI (P = .65). Regarding restricted diffusion, qDWI revealed three cases, while two cases were found on cDWI (P = .66). CONCLUSION qDWI induced fewer artifacts compared with cDWI in sedated patients, and similar frequencies of artifacts were induced by qDWI and by cDWI in unsedated patients. qDWI showed restricted diffusion comparable to cDWI.
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Affiliation(s)
- Satoshi Nakajima
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Gosuke Okubo
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Akihiko Sakata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Takuya Hinoda
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Yusuke Yokota
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Sonoko Oshima
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Sayo Otani
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Tomohisa Okada
- Human Brain Research Center, Kyoto University Graduate School of Medicine
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
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12
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Hirano Y, Miyawaki S, Imai H, Hongo H, Teranishi Y, Dofuku S, Ishigami D, Ohara K, Koizumi S, Ono H, Nakatomi H, Saito N. Differences in Clinical Features among Different Onset Patterns in Moyamoya Disease. J Clin Med 2021; 10:jcm10132815. [PMID: 34202349 PMCID: PMC8267932 DOI: 10.3390/jcm10132815] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 12/02/2022] Open
Abstract
Moyamoya disease is characterized by severe stenosis at the ends of the bilateral internal carotid arteries and the development of collateral circulation. The disease is very diverse in terms of age at onset, onset patterns, radiological findings, and genetic phenotypes. The pattern of onset is mainly divided into ischemic and hemorrhagic onsets. Recently, the opportunity to identify asymptomatic moyamoya disease, which sometimes manifests as nonspecific symptoms such as headache and dizziness, through screening with magnetic resonance imaging has been increasing. Various recent reports have investigated the associations between the clinical features of different onset patterns of moyamoya disease and the corresponding imaging characteristics. In this article, we have reviewed the natural history, clinical features, and imaging features of each onset pattern of moyamoya disease.
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Affiliation(s)
- Yudai Hirano
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (H.I.); (H.H.); (Y.T.); (S.D.); (D.I.); (K.O.); (S.K.); (H.O.); (H.N.); (N.S.)
- Department of Neurosurgery, Fuji Brain Institute and Hospital Fujinomiya, Shizuoka 418-0021, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (H.I.); (H.H.); (Y.T.); (S.D.); (D.I.); (K.O.); (S.K.); (H.O.); (H.N.); (N.S.)
- Correspondence: ; Tel.: +81-35-800-8853
| | - Hideaki Imai
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (H.I.); (H.H.); (Y.T.); (S.D.); (D.I.); (K.O.); (S.K.); (H.O.); (H.N.); (N.S.)
- Department of Neurosurgery, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Shinjuku-ku, Tokyo 162-8543, Japan
| | - Hiroki Hongo
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (H.I.); (H.H.); (Y.T.); (S.D.); (D.I.); (K.O.); (S.K.); (H.O.); (H.N.); (N.S.)
| | - Yu Teranishi
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (H.I.); (H.H.); (Y.T.); (S.D.); (D.I.); (K.O.); (S.K.); (H.O.); (H.N.); (N.S.)
| | - Shogo Dofuku
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (H.I.); (H.H.); (Y.T.); (S.D.); (D.I.); (K.O.); (S.K.); (H.O.); (H.N.); (N.S.)
| | - Daiichiro Ishigami
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (H.I.); (H.H.); (Y.T.); (S.D.); (D.I.); (K.O.); (S.K.); (H.O.); (H.N.); (N.S.)
| | - Kenta Ohara
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (H.I.); (H.H.); (Y.T.); (S.D.); (D.I.); (K.O.); (S.K.); (H.O.); (H.N.); (N.S.)
| | - Satoshi Koizumi
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (H.I.); (H.H.); (Y.T.); (S.D.); (D.I.); (K.O.); (S.K.); (H.O.); (H.N.); (N.S.)
| | - Hideaki Ono
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (H.I.); (H.H.); (Y.T.); (S.D.); (D.I.); (K.O.); (S.K.); (H.O.); (H.N.); (N.S.)
- Department of Neurosurgery, Fuji Brain Institute and Hospital Fujinomiya, Shizuoka 418-0021, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (H.I.); (H.H.); (Y.T.); (S.D.); (D.I.); (K.O.); (S.K.); (H.O.); (H.N.); (N.S.)
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo 181-8611, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (H.I.); (H.H.); (Y.T.); (S.D.); (D.I.); (K.O.); (S.K.); (H.O.); (H.N.); (N.S.)
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13
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Karsten MB, Smith ER, Scott RM. Late morbidity and mortality following revascularization surgery for moyamoya disease in the pediatric population. J Neurosurg Pediatr 2021; 28:206-211. [PMID: 34116511 DOI: 10.3171/2021.1.peds20944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There are limited reports on long-term morbidity in pediatric patients who have undergone surgical revascularization for moyamoya disease (MMD). Here, the authors report long-term morbidity and mortality in a population of pediatric patients who underwent pial synangiosis for MMD from 1988 through 2016. METHODS A single-center retrospective review of the hospital and personal operative databases of the senior authors was carried out to identify all patients who were treated for MMD at Boston Children's Hospital between 1988 and 2016, and who experienced any episode of late morbidity or mortality, which the authors defined as an event resulting in significant neurological deficit or death occurring more than 1 year after revascularization surgery. Hospital records were reviewed to determine pertinent demographic data, the initial mode of patient presentation, and associated comorbidities. Radiographic studies, when available, were reviewed for documentation of the diagnosis and for confirmation of the late complication, and the literature on this topic was reviewed. RESULTS In total, 460 patients with MMD underwent surgery between 1988 and 2016 using the pial synangiosis surgical technique; 15 (3.3%) of these patients (9 females and 6 males) experienced documented late death (n = 14) or severe morbidity (n = 1). The median age at revascularization surgery was 8.0 years (range 1-21 years). The causes of these late complications were grouped into three etiologies: intraventricular or intracerebral hemorrhage (n = 8), systemic complications related to associated comorbidities or preoperative disabilities (n = 5), and the development of malignant brain tumors (n = 2). Four patients whose MMD was associated with a history of cranial radiation therapy died. These events occurred from as early as 2 years to as late as 27 years postoperatively. CONCLUSIONS The risk of late morbidities and mortality following pial synangiosis for MMD in the pediatric patient appeared to be low. Nevertheless, the occurrence of catastrophic cerebrovascular events, particularly intracerebral and intraventricular hemorrhage in the otherwise neurologically stable revascularized patient, was concerning. Although there is value in long-term surveillance of patients who have undergone surgery for MMD, from both a neurological and a general medical standpoint, particularly in patients with the risk factor of prior cranial radiation therapy, it is not clear from the data how the late deaths in this population could have been prevented.
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14
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Hayashi T, Kimiwada T, Karibe H, Shirane R, Sasaki T, Metoki H, Tominaga T. Preoperative Risks of Cerebral Infarction in Pediatric Moyamoya Disease. Stroke 2021; 52:2302-2310. [PMID: 33971740 DOI: 10.1161/strokeaha.120.032699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Toshiaki Hayashi
- Department of Neurosurgery, Miyagi Children's Hospital, Sendai, Japan (T.H., T.K., R.S.)
| | - Tomomi Kimiwada
- Department of Neurosurgery, Miyagi Children's Hospital, Sendai, Japan (T.H., T.K., R.S.)
| | - Hiroshi Karibe
- Department of Neurosurgery, Sendai City Hospital, Japan (H.K.)
| | - Reizo Shirane
- Department of Neurosurgery, Miyagi Children's Hospital, Sendai, Japan (T.H., T.K., R.S.)
| | - Tatsuya Sasaki
- Department of Neurosurgery (T.S.), Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology (H.M.), Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan (T.T.)
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15
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Wang J, Zhang Q, Lu X, Liang Q, Wang Y, Zhu Y, Na S, Liu F, Tang L, Yang Y. Recurrent hemorrhage risk associated with medial target medullary artery anastomosis from the periventricular collateral vessel in adult patients with moyamoya disease. BMC Neurol 2021; 21:102. [PMID: 33676422 PMCID: PMC7936479 DOI: 10.1186/s12883-021-02130-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the association between periventricular target collateral anastomosis and recurrent ipsilateral hemorrhage has been evaluated in adult patients with moyamoya disease (MMD), no studies have investigated the relationship between target anastomotic territory and recurrent ipsilateral hemorrhage. The goal of this study was to assess this association. METHODS Consecutive adult MMD patients who had experienced initial intracranial hemorrhage and undergone conservative treatment were included. Two readers assessed angiographic results to identify the target anastomotic territory (medial medullary artery, lateral medullary artery, multiple medullary arteries, or nonmedullary artery) responsible for the hemorrhage. Cox proportional hazard regression models were used to estimate the risk of recurrent hemorrhage. RESULTS In the 36 hemispheres with initial hemorrhage, the target anastomotic territory was in the anastomotic territory of the medial medullary artery in 10 (27.8%), lateral medullary artery in 15 (41.7%), multiple medullary arteries in 2 (5.6%), and a nonmedullary artery in 9 (25.0%) hemispheres. During 45.1 ± 40.0 months of follow-up, recurrent ipsilateral hemorrhage occurred in 44.4% (16/36) of hemispheres. The target anastomotic territories responsible for the recurrent event were in the anastomotic territory of the medial medullary artery in 9 (56.3%) hemispheres, lateral medullary artery in 6 (37.5%) hemispheres, and multiple medullary arteries in 1 (6.3%) hemisphere. The anastomotic territory of the medial medullary artery was associated with recurrent hemorrhage before (HR = 2.94; 95% CI, 1.07-8.08; p = 0.037) and after (HR = 6.65; 95% CI, 1.32-33.60; p = 0.022) adjustments were made for confounding factors. CONCLUSIONS The incidence of recurrent ipsilateral hemorrhage varies with the target anastomotic territory in adult patients with MMD. Medial target medullary artery anastomosis is a significant risk factor for recurrent ipsilateral hemorrhage.
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Affiliation(s)
- Jian Wang
- Department of Neurosurgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China.,Comprehensive stroke center, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Qingrong Zhang
- Department of Neurosurgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xia Lu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Qun Liang
- Department of Neurosurgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yi Wang
- Department of Neurosurgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yichao Zhu
- Department of Physiology, Nanjing Medical University, Nanjing, China
| | - Shijie Na
- Department of Neurosurgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Fang Liu
- Department of Neurosurgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China.,Comprehensive stroke center, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Liming Tang
- Comprehensive stroke center, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China.,Department of Gastrointestinal Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yongbo Yang
- Department of Neurosurgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
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16
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Clinical outcomes after revascularization for pediatric moyamoya disease and syndrome: A single-center series. J Clin Neurosci 2020; 79:137-143. [PMID: 33070883 DOI: 10.1016/j.jocn.2020.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 11/22/2022]
Abstract
Moyamoya is a progressive cerebrovascular arteriopathy that affects children of any age. The goal of this study was to determine imaging and clinical outcomes as well as complication rates in a pediatric cohort undergoing either a combined direct/indirect or indirect-only revascularization approach. Patients with moyamoya disease or syndrome ≤ 18 years of age at the time of initial surgery were identified, and clinical data were collected retrospectively. Over a 12-year period, 26 patients underwent revascularization procedures on 49 hemispheres with a median follow-up of 2.6 years from surgery. Median age at surgery was 7.3 years (range 1.4-18.0 years). Thirty-three hemispheres (67.3%) underwent combined revascularization with a direct bypass and encephalomyosynangiosis, and sixteen hemispheres (32.7%) underwent indirect-only revascularization. The rate of 30-day perioperative complication was 10.2%, and the rate of postoperative clinical stroke by end of follow-up was 10.2% by hemisphere. There was a 5.7% rate of intraoperative bypass failure requiring conversion to an indirect revascularization approach. On follow-up imaging, 96.9% of direct bypasses remained patent. On multivariate analysis, higher preoperative Pediatric Stroke Outcome Measure (PSOM) scores were associated with lower rates of good clinical outcome on follow-up (unit OR 0.03; p = 0.03). Patients with age < 5.4 years had lower rates of good clinical outcome on follow-up. In this North American cohort, both combined direct/indirect and indirect only revascularization techniques were feasible. However, younger children < 5.4 years of age have worse outcomes than older children, similar to east Asian cohorts.
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17
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Hara S, Shimizu K, Nariai T, Kishino M, Kudo T, Umemoto T, Inaji M, Maehara T. De Novo Renal Artery Stenosis Developed in Initially Normal Renal Arteries during the Long-Term Follow-Up of Patients with Moyamoya Disease. J Stroke Cerebrovasc Dis 2020; 29:104786. [PMID: 32229075 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104786] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/06/2020] [Accepted: 02/24/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The de novo occurrence of renal artery stenosis in renal arteries that were angiographically confirmed to be normal in the past has never been reported before in patients with moyamoya disease. CASE DESCRIPTION During the long-term follow-up of pediatric patients with moyamoya disease, we observed 3 patients who developed de novo renal artery stenosis in arteries that had been angiographically confirmed to be normal 1 year after the surgery (7 years on average, ranging from 4 to 11 years). All of these patients were neurologically stable after successful indirect bypass surgery during childhood. However, more than 10 years after the surgery (15 years on average, ranging from 14 to 23 years), they developed hypertension and were found to have de novo renal artery stenosis, which was ameliorated by endovascular angioplasty. During the follow-up after angioplasty, 1 patient experienced a recurrence of hypertension and required a second and third angioplasty for restenosis. Another patient died of intracranial hemorrhage 2 years after angioplasty. In the 2 surviving patients, gene analysis of the ring finger protein 213 (RNF213; p.R4810K) point mutation, the susceptibility gene for moyamoya disease in the Asian population, was positive for the heterozygous variant. CONCLUSIONS De novo renal artery stenosis might develop in initially normal arteries during long-term follow-up, particularly among pediatric patients with moyamoya disease. Considering the extracranial manifestations of moyamoya disease, clinicians should keep in mind that de novo renal artery stenosis could emerge later in their life. Thus, it is crucial to continue to follow these patients for decades, even if the patients are neurologically stable after bypass surgery. Monitoring for blood pressure and the de novo occurrence of renal artery stenosis is important to prevent hypertension-related morbidity and mortality, such as intracranial hemorrhage, in this disease population.
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Affiliation(s)
- Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kazuhide Shimizu
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuhiro Kishino
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Kudo
- Department of Vascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomoyuki Umemoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
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18
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Kaseka ML, Dlamini N, Westmacott R. Ischemic sequelae and other vascular diseases. HANDBOOK OF CLINICAL NEUROLOGY 2020; 173:485-492. [PMID: 32958192 DOI: 10.1016/b978-0-444-64150-2.00033-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although pediatric stroke is associated with higher survival rates compared with adult stroke, a substantial body of evidence indicates significant neuropsychologic morbidity in pediatric stroke survivors. Neuroplasticity does not guarantee good outcome in children. The general trends observed in the literature are reviewed as is the profile observed in common causes of pediatric stroke: congenital heart disease, moyamoya disease, and sickle cell disease. The neuropsychologic profile of pediatric stroke patients is heterogeneous due to the multiplicity of associated causes. Stroke in early infancy and large strokes are associated with cognitive impairment while more limited disorders, such as phasic deficit, are observed in childhood stroke. Executive dysfunction is common in pediatric stroke, but social interaction skills are usually preserved. Congenital heart disease and sickle cell disease are associated with global neuropsychologic dysfunction while cognition is usually preserved in moyamoya. Executive dysregulation is instead more frequently reported in this population. Further study of maladaptive processes after pediatric stroke will allow identification of predictors of functional and neuropsychologic outcomes and permit personalization of care.
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Affiliation(s)
- Matsanga Leyila Kaseka
- Department of Pediatrics, Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada.
| | - Nomazulu Dlamini
- Department of Pediatrics, Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Westmacott
- Department of Psychology, Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
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19
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Li J, Liu X, Zhang D, Zhang Y, Wang R, Yuan J, Zhao J. Cognitive Performance Profile in Pediatric Moyamoya Disease Patients and Its Relationship With Regional Cerebral Blood Perfusion. Front Neurol 2019; 10:1308. [PMID: 31920931 PMCID: PMC6920207 DOI: 10.3389/fneur.2019.01308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/26/2019] [Indexed: 11/13/2022] Open
Abstract
Object: Moyamoya disease affects the cognitive function of pediatric patients, and compromised cerebral blood flow might be the potential cause. We aimed to explore the specific correlation between cognitive impairment and regional perfusion status in pediatric moyamoya disease patients. Methods: We prospectively enrolled consecutive pediatric moyamoya disease patients admitted to Beijing Tiantan Hospital from July 2017 to March 2019. Arterial spin-labeling magnetic resonance and the Wechsler Intelligence Scale for Children (the 4th edition) were performed on all participants. The cognitive performance of patients was analyzed, and its correlation to cerebral perfusion status was also investigated in the region of interest-based analysis. Results: A total of 21 patients met the inclusion criteria (mean aged 11.14 ± 2.82, male: female = 11:10). Six patients (28.6%) showed no cognitive deficits in any index score, while 15 (71.4%) showed cognitive deficits with differing severity. Nine (42.9%) patients showed overall cognitive impairment, and all cognitive index scores except for Verbal Comprehension Index were significantly lower than the mean scores of normative data with corresponding age. Perceptual Reasoning Index (p = 0.019) were statistically lower in patients with radiologically confirmed cerebral infarction. Suzuki stage of the left hemisphere negatively correlated to Full-scale Intelligence Quotient (r = −0.452, p = 0.039). Region of Interest analysis showed that cerebral blood flow of the left temporal lobe independently associated with the Processing Speed Index (β = 0.535, p = 0.041). Conclusion: Pediatric moyamoya disease patients exhibited different levels of cognitive impairment. Cerebral infarction is related to poorer perceptual reasoning ability. Cerebral blood flow in the left temporal lobe positively correlates with processing speed.
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Affiliation(s)
- Jiaxi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xingju Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Jing Yuan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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20
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Funaki T, Kataoka H, Yoshida K, Kikuchi T, Mineharu Y, Okawa M, Yamao Y, Miyamoto S. The Targeted Bypass Strategy for Preventing Hemorrhage in Moyamoya Disease: Technical Note. Neurol Med Chir (Tokyo) 2019; 59:517-522. [PMID: 31656238 PMCID: PMC6923163 DOI: 10.2176/nmc.tn.2019-0162] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although direct bypass is effective at preventing intracranial hemorrhage in moyamoya disease, the optimal strategy for achieving this purpose has rarely been addressed. The tailored targeting bypass strategy is a novel technical modification of direct bypass focused on hemorrhage prevention. The strategy is based on the promising theory of periventricular anastomosis, which explains the mechanism of hemorrhage in moyamoya disease. The strategy is defined as the use of multi-imaging modalities to predetermine in a tailored manner a target vessel at the point at which the medullary artery directly extends from the periventricular anastomosis of interest. Direct bypass with a wide craniotomy was performed on 13 hemispheres in eight patients according to this strategy. Marked shrinkage of the periventricular anastomosis of interest was observed in all but one hemisphere after surgery, and no new hemorrhages have occurred as of this writing. The present case series illustrates the technical aspects and preliminary results of the tailored targeting bypass strategy, an approach that might expand the potential of direct bypass in preventing hemorrhage.
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Affiliation(s)
- Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Hiroharu Kataoka
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Yohei Mineharu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Masakazu Okawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
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21
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Yamao Y, Takahashi JC, Funaki T, Mineharu Y, Kikuchi T, Okada T, Togashi K, Miyamoto S. Revascularization Surgery in Childhood Associated with a Low Incidence of Microbleeds in Adult Patients with Moyamoya. World Neurosurg 2019; 133:e716-e721. [PMID: 31589987 DOI: 10.1016/j.wneu.2019.09.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical significance of asymptomatic microbleeds in moyamoya disease remains unclear. The purpose of this study was to clarify the relationship between bypass surgery and the incidence of asymptomatic microbleeds. METHODS This retrospective study included 142 adult patients (mean age, 37.7 ± 13.5 years) with moyamoya disease, 36 of whom (25.3%) underwent bypass surgery in childhood. Hemorrhagic onset was diagnosed in 31 patients (21.8%). The incidence of microbleeds was evaluated on T2*-weighted or susceptibility-weighted imaging from 3-T magnetic resonance imaging. The patients were subsequently categorized into MBs (microbleeds) or non-MBs groups. Because previous microbleeds potentially lead to hemorrhage, the MBs group was defined as patients with radiographic evidence of bleeding, including asymptomatic microbleeds and/or hemorrhagic onset. The association of baseline characteristics was evaluated. RESULTS Asymptomatic microbleeds were detected in 38 patients (26.8%). Of 31 patients with hemorrhagic onset, 18 had microbleeds, whereas 13 had no microbleeds. Therefore, 51 patients (35.9%) were classified into the MBs group. Bypass surgery in childhood (MBs, 7.8% vs. non-MBs, 35.2%; P < 0.01) and age (MBs, 42.9 ± 1.8 years vs. non-MBs, 34.7 ± 1.4 years; P < 0.01) were statistically significant factors associated with microbleeds, but only bypass surgery in childhood remained statistically significant after multivariable adjustment (odds ratio, 0.25; 95% confidence interval, 0.07-0.87; P = 0.03). CONCLUSIONS This study shows the clinical significance of revascularization surgery in childhood associated with a low incidence of asymptomatic microbleeds in adult patients with moyamoya disease. This finding indicates that a newly established bypass can reduce hemodynamic overstress.
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Affiliation(s)
- Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Jun C Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Research Center Hospital, Suita, Japan
| | - Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yohei Mineharu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takyuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomohisa Okada
- Department of Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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22
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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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23
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Zhao Y, Yu S, Li J, Lu J, Zhang Q, Zhang D, Wang R, Zhao Y. Modified encephalo-duro-periosteal-synangiosis (EDPS) for the revascularization of anterior cerebral artery territory in moyamoya disease: A single-center experience. Clin Neurol Neurosurg 2019; 178:86-92. [PMID: 30763783 DOI: 10.1016/j.clineuro.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/29/2019] [Accepted: 02/03/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Anterior cerebral artery (ACA) territory, a crucial area of intellectual development in children, is frequently involved in the progress of moyamoya disease (MMD). However, revascularization surgeries for this area are not as established as surgeries for middle cerebral artery (MCA) territory. This study aimed to describe our experience and study the effect of revascularizing ACA territory with periocranium and dural leaflets, which is referred to as 'encephalo-duro-periosteal-synangiosis (EDPS)'. PATIENTS AND METHOD Fourteen hemispheres of 9 MMD patients who had undergone EDPS from November 2015 till July 2017 in our hospital were retrospectively included. Clinical characteristics and procedure-related information were recorded. Cerebral perfusion was evaluated by computed tomography perfusion (CTP). Absolute and relative (r) CTP parameters of ROIs in ACA territory at the level of centrum semiovale and middle basal ganglia were calculated. Preoperative and postoperative parameters were compared. RESULTS All EDPS procedures were technically successful with no postoperative complications. The mean operating time was 75.00 ± 22.53 min per hemisphere. Postoperative absolute cerebral blood flow (CBF), rCBF were significantly increased and absolute time to peak (TTP), rTTP, absolute mean transit time (MTT) were significantly reduced in ACA territory at centrum semiovale level (P = 0.002, 0.045, 0.007, 0.005 and 0.039 respectively). Improved outcomes were achieved in five patients, stabilization in three and one patient had deterioration out of intracerebral hemorrhage during follow-up. CONCLUSION EDPS is a simple but effective technique to revascularize ACA territory for MMD. EDPS significantly improved cerebral blood perfusion of frontal lobe in the majority of patients without increasing procedure-related risks.
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Affiliation(s)
- Yahui Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road, Beijing, 100070, China
| | - Shaochen Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road, Beijing, 100070, China
| | - Jiaxi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road, Beijing, 100070, China
| | - Junlin Lu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road, Beijing, 100070, China
| | - Qian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road, Beijing, 100070, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road, Beijing, 100070, China.
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road, Beijing, 100070, China
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring Road, Beijing, 100070, China.
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