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Wang H, Hao F, Feng J, Zhang Q, Zhang Z, Li B, Zhang H, Yu X, Han C, Duan L. Clinical Course, Therapy, and Long-Term Outcomes of Children With Moyamoya Disease and Posterior Cerebral Artery Involvement. Neurology 2024; 103:e209658. [PMID: 38991203 DOI: 10.1212/wnl.0000000000209658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Posterior cerebral artery involvement (PCAi) has been identified as an important factor related to poor prognosis in moyamoya disease (MMD). This study summarized the characteristics of children with MMD and PCAi, clarified the clinical course, identified prognostic predictors, and investigated the long-term effect of encephaloduroarteriosynangiosis for posterior circulation (EDAS-p). METHODS We retrospectively reviewed all our pediatric MMD cases with follow-up angiograms from November 2003 to December 2016. PCAi was classified as early-onset at initial diagnosis and delayed-onset after anterior circulation revascularization. Multivariable data including clinical features, radiographic findings, and surgical outcomes were analyzed. RESULTS Among 570 children with MMD, 246 (43.2%) had PCAi, with 176 (30.9%) classified as early-onset PCAi. During a median follow-up period of 10 years, 17.8% (70/394) of patients without initial PCAi developed delayed-onset PCAi. The median time to detection of a new PCA lesion was 15.5 (range 7-110) months from initial diagnosis, with a median age of 10.5 (3-22). Younger age at onset, familial occurrence, advanced Suzuki stages, and preoperative infarctions were predictors of delayed-onset PCAi. EDAS-p was performed on 294 hemispheres of 195 patients with PCAi. Stroke-free survival was significantly higher in the EDAS-p group than in the non-EDAS-p group (99.0% vs 90.2%; p < 0.001 [Breslow test]; p = 0.001 [log-rank test]; median follow-up: 101 months). DISCUSSION PCAi is not uncommon in children with MMD, underscoring the need for long-term close clinical monitoring, especially in patients with high-risk factors for PCA progression. EDAS-p may be a safe and effective procedure for preventing subsequent stroke in children with MMD and PCAi.
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Affiliation(s)
- Hui Wang
- From the Department of Neurosurgery (H.W., F.H., J.F., Q.Z., Z.Z., B.L., H.Z., X.Y., C.H., L.D.), Chinese PLA General Hospital; and Chinese PLA Medical School (F.H.), Beijing, China
| | - Fangbin Hao
- From the Department of Neurosurgery (H.W., F.H., J.F., Q.Z., Z.Z., B.L., H.Z., X.Y., C.H., L.D.), Chinese PLA General Hospital; and Chinese PLA Medical School (F.H.), Beijing, China
| | - Jie Feng
- From the Department of Neurosurgery (H.W., F.H., J.F., Q.Z., Z.Z., B.L., H.Z., X.Y., C.H., L.D.), Chinese PLA General Hospital; and Chinese PLA Medical School (F.H.), Beijing, China
| | - Qian Zhang
- From the Department of Neurosurgery (H.W., F.H., J.F., Q.Z., Z.Z., B.L., H.Z., X.Y., C.H., L.D.), Chinese PLA General Hospital; and Chinese PLA Medical School (F.H.), Beijing, China
| | - Zhengshan Zhang
- From the Department of Neurosurgery (H.W., F.H., J.F., Q.Z., Z.Z., B.L., H.Z., X.Y., C.H., L.D.), Chinese PLA General Hospital; and Chinese PLA Medical School (F.H.), Beijing, China
| | - Bin Li
- From the Department of Neurosurgery (H.W., F.H., J.F., Q.Z., Z.Z., B.L., H.Z., X.Y., C.H., L.D.), Chinese PLA General Hospital; and Chinese PLA Medical School (F.H.), Beijing, China
| | - Houdi Zhang
- From the Department of Neurosurgery (H.W., F.H., J.F., Q.Z., Z.Z., B.L., H.Z., X.Y., C.H., L.D.), Chinese PLA General Hospital; and Chinese PLA Medical School (F.H.), Beijing, China
| | - Xinguang Yu
- From the Department of Neurosurgery (H.W., F.H., J.F., Q.Z., Z.Z., B.L., H.Z., X.Y., C.H., L.D.), Chinese PLA General Hospital; and Chinese PLA Medical School (F.H.), Beijing, China
| | - Cong Han
- From the Department of Neurosurgery (H.W., F.H., J.F., Q.Z., Z.Z., B.L., H.Z., X.Y., C.H., L.D.), Chinese PLA General Hospital; and Chinese PLA Medical School (F.H.), Beijing, China
| | - Lian Duan
- From the Department of Neurosurgery (H.W., F.H., J.F., Q.Z., Z.Z., B.L., H.Z., X.Y., C.H., L.D.), Chinese PLA General Hospital; and Chinese PLA Medical School (F.H.), Beijing, China
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Shieh A, Schoenheit TR, Mallon ST, Mathias EJ. Acute Weakness in a Toddler with Sickle Cell Disease. Pediatr Rev 2024; 45:296-300. [PMID: 38689111 DOI: 10.1542/pir.2022-005746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
| | | | - Shane T Mallon
- Division of Emergency Radiology, University of Michigan, Ann Arbor, MI
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Montaser A, Kappel AD, Driscoll J, Day E, Karsten M, See AP, Orbach DB, Smith ER. Posterior cerebral territory ischemia in pediatric moyamoya: Surgical techniques and long-term clinical and radiographic outcomes. Childs Nerv Syst 2024; 40:791-800. [PMID: 37955716 DOI: 10.1007/s00381-023-06219-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To describe a surgical technique for posterior cerebral revascularization in pediatric patients with moyamoya arteriopathy. Here, we describe the clinical characteristics, surgical indications, operative techniques, and clinical and radiographic outcomes in a series of pediatric patients with moyamoya disease affecting the posterior cerebral artery (PCA) territory. METHODS A retrospective single-center series of all pediatric patients with moyamoya disease who presented to our institute between July 2009 through August 2019 were reviewed. The clinical characteristics, surgical indications, operative techniques, and long-term clinical and radiographic outcomes of pediatric moyamoya patients with PCA territory ischemia were collected and analyzed. RESULTS A total of 10 PCA revascularization procedures were performed in 9 patients, 5 female, ages 1 to 11.1 years (average 5.2 years). Complications included 1 stroke, with no infections, hemorrhages, seizures, or deaths. One patient had less than 1 year of radiographic and clinical follow-up. In 8 of 9 patients with at least 1 year of radiographic follow-up, there was engraftment of surgical vessels present in all cases. No new strokes were identified on long-term follow-up despite the radiographic progression of the disease. In the 8 cases available for analysis, the average follow-up was 50.8 months with a range of 12 to 117 months. CONCLUSIONS PCA territory ischemia in patients with progressive moyamoya disease can be surgically treated with indirect revascularization. Here, we describe our experience with PCA revascularization procedures for moyamoya disease, including pial pericranial dural (PiPeD) revascularization and pial synangiosis utilizing the occipital artery. These surgical options may be useful for decreasing the risk of stroke in pediatric moyamoya patients with severe posterior circulation disease.
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Affiliation(s)
- Alaa Montaser
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Ari D Kappel
- Vascular Biology Program, Department of Neurosurgery Boston Children's Hospital, Hunnewell 2nd floor, 300 Longwood Ave, Harvard Medical School, Boston, MA, 02115, USA
- Department of Interventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica Driscoll
- Vascular Biology Program, Department of Neurosurgery Boston Children's Hospital, Hunnewell 2nd floor, 300 Longwood Ave, Harvard Medical School, Boston, MA, 02115, USA
| | - Emily Day
- Vascular Biology Program, Department of Neurosurgery Boston Children's Hospital, Hunnewell 2nd floor, 300 Longwood Ave, Harvard Medical School, Boston, MA, 02115, USA
| | - Madeline Karsten
- Vascular Biology Program, Department of Neurosurgery Boston Children's Hospital, Hunnewell 2nd floor, 300 Longwood Ave, Harvard Medical School, Boston, MA, 02115, USA
| | - Alfred P See
- Vascular Biology Program, Department of Neurosurgery Boston Children's Hospital, Hunnewell 2nd floor, 300 Longwood Ave, Harvard Medical School, Boston, MA, 02115, USA
- Department of Interventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Darren B Orbach
- Department of Interventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward R Smith
- Vascular Biology Program, Department of Neurosurgery Boston Children's Hospital, Hunnewell 2nd floor, 300 Longwood Ave, Harvard Medical School, Boston, MA, 02115, USA.
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Yamao Y, Funaki T, Yamada H, Okawa M, Mineharu Y, Kikuchi T, Fushimi Y, Kataoka H, Yoshida K, Takahashi JC, Miyamoto S, Arakawa Y. "Transcallosal" periventricular anastomosis in moyamoya disease: the fourth periventricular anastomosis and a potential predictor of hemorrhage. J Stroke Cerebrovasc Dis 2023; 32:107428. [PMID: 37924782 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107428] [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: 07/04/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVES Choroidal anastomosis is a risk factor for hemorrhage in moyamoya disease. One variant of choroidal anastomosis, "transcallosal anastomosis," originates from the medial posterior choroidal artery, and penetrates the corpus callosum to reconstruct the pericallosal artery. We aimed to investigate the prevalence and the bleeding rate of transcallosal anastomosis using sliding thin-slab maximum intensity projection reformatted from magnetic resonance angiography (MRA). MATERIALS AND METHODS This study included 222 patients. We defined transcallosal anastomosis grades (0-2) and the stenosis of the anterior (ACA, 0-2), middle (MCA, 1-3), and posterior cerebral artery (PCA, 0-2) by MRA scores, independently by two coauthors. RESULTS Grade-2 transcallosal anastomosis was detected in 21 patients (9.5 %). There were no correlations of the incidence of transcallosal anastomosis with previous bypass surgery (P = 0.23). Multivariate analysis revealed a significantly higher incidence in hemorrhagic onset and younger age (odds ratio [OR] 3.77, and 0.97). Transcallosal anastomosis had statistically significant correlation with ACA and PCA scores (P = 0.01 and 0.03), but not with MCA scores (P = 0.1). In multivariate analysis, ACA scores 1 and 2 were significantly higher (OR, 15.44 and 11.17), and PCA score 1 was also higher (OR, 3.07), but PCA score 2 was not. Interrater agreement for judgment of transcallosal anastomosis grade was strong (κ = 0.89). Two patients with Grade-2 transcallosal anastomosis had late hemorrhage in the corpus callosum (bleeding rate: 2.5 % per year). CONCLUSIONS Transcallosal anastomosis may be associated with both advanced ACA and moderate PCA stenosis, and cause hemorrhage at the corpus callosum.
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Affiliation(s)
- Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroki Yamada
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masakazu Okawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yohei Mineharu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Jun C Takahashi
- Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Moyamoya Disease Support Center, Kyoto University Hospital, Kyoto, Japan; Stroke Support Center, Kyoto University Hospital, Kyoto, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Arficho KT, Gumma C, Chakko MN. Post Cryptococcal Moyamoya Syndrome in Adult Human Immunodeficiency Virus Patient With Anterior and Posterior Circulation Involvement: Case Report. Cureus 2023; 15:e44052. [PMID: 37746378 PMCID: PMC10517719 DOI: 10.7759/cureus.44052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Moyamoya disease (MMD) is a rare idiopathic progressive vaso-occlusive disease characterized by irreversible vascular occlusion and collateral development of distal internal carotid arteries. Initially perceived as an exclusive entity to the East Asian population, the disease is now being reported globally, affecting individuals of diverse ethnicities. We present a case of a 55-year-old African American male patient with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and a prior history of cryptococcal meningitis presenting to the emergency department with recurrent episodic headaches, which was refractory to routine medical therapy. Neuroimaging with computed tomography angiogram of the head and neck and magnetic resonance imaging of the brain led to the subsequent diagnosis of moyamoya syndrome (MMS). To our knowledge, MMS is uncommon in adult HIV/AIDS patients. It is crucial that clinicians are aware of the disease progression. For effective recognition and prevention of the condition, it is of utmost importance that clinicians possess a comprehensive understanding of the disease and its clinical manifestations.
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Affiliation(s)
- Kidist T Arficho
- Radiology, Ascension Providence Hospital, Michigan State University College of Human Medicine (MSUCHM), Southfield, USA
| | - Cezar Gumma
- Radiology, Beaumont Hospital, Farmington Hills, USA
| | - Mathew N Chakko
- Neuroradiology, Ascension Providence Hospital, Michigan State University College of Human Medicine (MSUCHM), Southfield, USA
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Seo YS, Lee S, Choi YH, Cho YJ, Lee SB, Cheon JE. Monitoring Posterior Cerebral Perfusion Changes With Dynamic Susceptibility Contrast-Enhanced Perfusion MRI After Anterior Revascularization Surgery in Pediatric Moyamoya Disease. Korean J Radiol 2023; 24:784-794. [PMID: 37500579 PMCID: PMC10400367 DOI: 10.3348/kjr.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE To determine whether dynamic susceptibility contrast-enhanced (DSC) perfusion magnetic resonance imaging (MRI) can be used to evaluate posterior cerebral circulation in pediatric patients with moyamoya disease (MMD) who underwent anterior revascularization. MATERIALS AND METHODS This study retrospectively included 73 patients with MMD who underwent DSC perfusion MRI (age, 12.2 ± 6.1 years) between January 2016 and December 2020, owing to recent-onset clinical symptoms during the follow-up period after completion of anterior revascularization. DSC perfusion images were analyzed using a dedicated software package (NordicICE; Nordic NeuroLab) for the middle cerebral artery (MCA), posterior cerebral artery (PCA), and posterior border zone between the two regions (PCA-MCA). Patients were divided into two groups; the PCA stenosis group included 30 patients with newly confirmed PCA involvement, while the no PCA stenosis group included 43 patients without PCA involvement. The relationship between DSC perfusion parameters and PCA stenosis, as well as the performance of the parameters in discriminating between groups, were analyzed. RESULTS In the PCA stenosis group, the mean follow-up duration was 5.3 years after anterior revascularization, and visual disturbances were a common symptom. Normalized cerebral blood volume was increased, and both the normalized time-to-peak (nTTP) and mean transit time values were significantly delayed in the PCA stenosis group compared with those in the no PCA stenosis group in the PCA and PCA-MCA border zones. TTPPCA (odds ratio [OR] = 6.745; 95% confidence interval [CI] = 2.665-17.074; P < 0.001) and CBVPCA-MCA (OR = 1.567; 95% CI = 1.021-2.406; P = 0.040) were independently associated with PCA stenosis. TTPPCA showed the highest receiver operating characteristic curve area in discriminating for PCA stenosis (0.895; 95% CI = 0.803-0.986). CONCLUSION nTTP can be used to effectively diagnose PCA stenosis. Therefore, DSC perfusion MRI may be a valuable tool for monitoring PCA stenosis in patients with MMD.
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Affiliation(s)
- Yun Seok Seo
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seul Bi Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Zheng S, Wang F, Cheng L, Li R, Zhang D, He W, Zhang W. Ultrasound parameters associated with stroke in patients with moyamoya disease: a logistic regression analysis. Chin Neurosurg J 2022; 8:32. [PMID: 36221122 PMCID: PMC9555074 DOI: 10.1186/s41016-022-00300-5] [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: 08/15/2022] [Accepted: 09/19/2022] [Indexed: 11/07/2022] Open
Abstract
Background Moyamoya disease can lead to stroke with devastating consequences, it is necessary to find a non-invasive and effective approach to identify the occurrence of stroke. In this study, we aim to analyze the association between ultrasound parameters and ipsilateral cerebral hemisphere stroke in patients with moyamoya disease by logistic regression analysis. Methods In this retrospective case–control study, 88 patients with MMD (153 cerebral hemispheres) hospitalized in Beijing Tiantan Hospital, Capital Medical University from November 2020 to October 2021 were analyzed. According to the occurrence of stroke, the 153 cerebral hemispheres were divided into a stroke group and a non-stroke group. Clinical data and ultrasound parameters of the ipsilateral internal carotid artery, superficial temporal artery, maxillary artery, and posterior cerebral artery were recorded. The ultrasound parameters were divided into four groups according to interquartile range, and then they were compared between the stroke group and the non-stroke group. Those with significant differences were scored by multivariate logistic regression analysis. Results There were 75 cerebral hemispheres (49.0%) in the stroke group and 78 cerebral hemispheres (51.0%) in the non-stroke group. Logistic regression analysis showed that the internal diameter of the internal carotid artery, peak systolic velocity of the internal carotid artery and peak systolic velocity of the posterior cerebral artery were independently correlated factors for stroke in patients with MMD. The fourth quartile group of the above three ultrasound parameters was taken as the reference group, and the odds ratio of the first quartile group were 11.679 (95% CI 2.918–46.749, P = 0.001), 19.594 (95% CI 4.973–77.193, P < 0.001), and 11.657 (95% CI 3.221–42.186, P < 0.001), respectively. Conclusion Ultrasound parameters are independently correlated with ipsilateral cerebral stroke in patients with MMD. Ultrasound provides a new way to identify stroke in MMD patients. Future prospective cohort studies are needed to verify the clinical value of ultrasound in identifying patients with MMD at high risk of stroke.
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Affiliation(s)
- Shuai Zheng
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai District, Beijing, 100070 People’s Republic of China
| | - Fumin Wang
- grid.411472.50000 0004 1764 1621Department of Ultrasound, Peking University First Hospital, No. 8, Xishiku street, Xicheng District, Beijing, 100034 People’s Republic of China
| | - Linggang Cheng
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai District, Beijing, 100070 People’s Republic of China
| | - Rui Li
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai District, Beijing, 100070 People’s Republic of China
| | - Dong Zhang
- grid.414350.70000 0004 0447 1045Department of Neurosurgery, Beijing Hospital, No.1, Dahua Road, Dongdan, Dongcheng District, Beijing, 100730 People’s Republic of China ,grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai District, Beijing, 100070 People’s Republic of China
| | - Wen He
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai District, Beijing, 100070 People’s Republic of China
| | - Wei Zhang
- grid.411617.40000 0004 0642 1244Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai District, Beijing, 100070 People’s Republic of China
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Ihara M, Yamamoto Y, Hattori Y, Liu W, Kobayashi H, Ishiyama H, Yoshimoto T, Miyawaki S, Clausen T, Bang OY, Steinberg GK, Tournier-Lasserve E, Koizumi A. Moyamoya disease: diagnosis and interventions. Lancet Neurol 2022; 21:747-758. [DOI: 10.1016/s1474-4422(22)00165-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 12/14/2022]
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Araki Y, Yokoyama K, Uda K, Kanamori F, Mamiya T, Takayanagi K, Ishii K, Nishihori M, Takeuchi K, Tanahashi K, Nagata Y, Tanei T, Nishimura Y, Izumi T, Saito R. Spatially separate cerebral infarction in the posterior cerebral artery territory after combined revascularization of the middle cerebral artery territory in an adult patient with moyamoya disease and fetal-type posterior communicating artery: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21704. [PMID: 36273866 PMCID: PMC9379675 DOI: 10.3171/case21704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Remote cerebral infarction after combined revascularization of the middle cerebral artery (MCA) territory is rare in patients with moyamoya disease (MMD) with a fetal-type posterior communicating artery (PCoA). OBSERVATIONS A 57-year-old woman developed numbness in her right upper limb and transient motor weakness and was diagnosed with MMD. She also had a headache attack and a scintillating scotoma in the right visual field. Preoperative magnetic resonance angiography (MRA) showed stenosis of the left posterior cerebral artery (PCA). Combined revascularization was performed for the left MCA territory. No new neurological deficits were observed for 2 days after the operation, but right hemianopia, alexia, and agraphia appeared on postoperative day (POD) 4. Magnetic resonance imaging showed a new left occipitoparietal lobe infarction, and MRA showed occlusion of the distal left PCA. After that point, the alexia and agraphia gradually improved, but right hemianopia remained at the time of discharge on POD 18. LESSONS Cerebral ischemia in the PCA territory may occur after combined revascularization of the MCA territory in patients with fetal-type PCoA. For these cases, a double-barrel bypass or indirect revascularization to induce a slow conversion could be considered on its own as a treatment option.
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Affiliation(s)
- Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan; and
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan; and
| | - Kenji Uda
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan; and
| | - Fumiaki Kanamori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan; and
| | - Takashi Mamiya
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan; and
| | - Kai Takayanagi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan; and
| | - Kazuki Ishii
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan; and
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan; and
| | - Kazuhito Takeuchi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan; and
| | - Kuniaki Tanahashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan; and
| | - Yuichi Nagata
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan; and
| | - Takafumi Tanei
- Department of Neurosurgery, Komaki City Hospital, Aichi, Japan
| | - Yusuke Nishimura
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan; and
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan; and
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan; and
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Zheng S, Ge P, Li Y, Wang J, Shi Z, Zhang J, He L, Cheng L, Zhang D, He W. Association Between Ultrasound Parameters and History of Ischemic or Hemorrhagic Stroke in Patients With Moyamoya Disease. Front Neurol 2021; 12:570843. [PMID: 33658969 PMCID: PMC7917293 DOI: 10.3389/fneur.2021.570843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To explore the association between ultrasound parameters and previous ischemic or hemorrhagic stroke in patients with moyamoya disease (MMD), and develop an ultrasound-based nomogram to identify stroke in patients with MMD. Methods: We prospectively enrolled 52 consecutive patients (92 hemispheres) with MMD at the Beijing Tiantan Hospital. Thirty-six patients (65 hemispheres) were assigned to the training dataset from September 2019 to February 2020, and 16 patients (27 hemispheres) were assigned to the validation dataset from March 2020 to July 2020. Multivariate logistic regression analysis was applied to identify ultrasound parameters associated with previous history of ipsilateral stroke in patients with MMD, and a nomogram was subsequently constructed to identify stroke in patients with MMD. The performance of the nomogram was evaluated with respect to discrimination, calibration, and clinical usefulness. Results: Multivariate analysis indicated that the flow volume (FV) of the extracranial internal carotid artery (EICA) and the peak systolic velocity (PSV) of the posterior cerebral artery (PCA) were independently associated with ipsilateral stroke in patients with MMD, a nomogram incorporating these two parameters was constructed to identify stroke patients. The area under the receiver operating characteristic (AUROC) curves was 0.776 (95% CI, 0.656–0.870) in the training dataset and 0.753 (95% CI, 0.550–0.897) in the validation dataset suggested that the model had good discrimination ability. The calibration plot showed good agreement in both the two datasets. The decision curve analysis (DCA) revealed that the nomogram was clinically useful. Conclusions: Ultrasound parameters of EICA and PCA are independently associated with history of previous ipsilateral ischemic or hemorrhagic stroke in patients with MMD. The present ultrasound-based nomogram might provide information to identify MMD patients with high risk of stroke. Future long-term follow-up studies are needed to prove the predictive value in other independent cohorts. Clinical Trial Registration:http://www.chictr.org.cn/index.aspx. Unique Identifier: ChiCTR1900026075.
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Affiliation(s)
- Shuai Zheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, 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.,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
| | - Yi Li
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jingzhe Wang
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhiyong Shi
- 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.,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
| | - Jinghan Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lei He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linggang Cheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, 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.,Beijing Translational Engineering Center for 3D Printer in Clinical Neuroscience, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Saito H, Kashiwazaki D, Uchino H, Yamamoto S, Houkin K, Kuroda S. Specific clinical features and one-stage revascularization surgery for moyamoya disease with severe cerebral ischemia in the territory of posterior cerebral artery. Acta Neurochir (Wien) 2021; 163:583-592. [PMID: 32929541 DOI: 10.1007/s00701-020-04580-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There are no reports describing the surgical procedure for moyamoya disease (MMD) patients with severe cerebral ischemia in the territory of the posterior cerebral artery (PCA) at initial presentation. In this study, therefore, we describe their clinical and radiological features and clinical results of one-stage revascularization surgery for both anterior and posterior circulation. METHODS This study included 6 MMD patients who had severe cerebral ischemia in the PCA territory and underwent one-stage revascularization surgery for both anterior and posterior circulation. Of these, one patient underwent it on both sides. Their clinical and radiological data were precisely analyzed. Compared with usual procedure, craniotomy was extended towards the temporo-parietal area more widely. The parietal branch of superficial temporal artery (STA) was anastomosed to the angular or posterior temporal artery, while the frontal branch was anastomosed to the frontal branch of MCA. Ultimate indirect bypass was added. Their clinical and radiological outcomes were evaluated. RESULTS Their neurological symptoms included visual and speech disturbance as well as numbness of the extremities. Cerebral infarct was distributed in the posterior temporal, parietal, and/or occipital lobe. Cerebral hemodynamics and metabolism were also impaired in the same regions. These findings were completely different from those in MMD patients without PCA lesion. Postoperative course was uneventful, and none of them recurred stroke during a mean follow-up period of 10.5 years. Surgical collaterals widely provided blood flow to the entire hemispheres, including the occipital lobe. Cerebral hemodynamics and metabolism markedly improved after surgery. CONCLUSION One-stage revascularization surgery for both anterior and posterior circulation is feasible and effective to prevent future stroke in MMD patients with severe cerebral ischemia in the PCA territory at initial presentation.
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Yamamoto S, Funaki T, Fujimura M, Takahashi JC, Uchino H, Houkin K, Tominaga T, Miyamoto S, Kuroda S. Development of Hemorrhage-prone Anastomoses in Asymptomatic Moyamoya Disease—A Comparative Study with Japan Adult Moyamoya Trial. J Stroke Cerebrovasc Dis 2019; 28:104328. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/22/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022] Open
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13
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Wang JZ, He W, Zhang D, Yu LB, Zhao YH, Cai JX. Changing Ischemic Lesion Patterns and Hemodynamics of the Posterior Cerebral Artery in Moyamoya Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2621-2630. [PMID: 30702756 DOI: 10.1002/jum.14959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/28/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The aim of this study was to determine how hemodynamics of the posterior cerebral artery (PCA) are associated with cerebral ischemic lesions in moyamoya disease (MMD). METHODS Thirty-six patients with ischemic MMD (Suzuki grade IV-V) were retrospectively analyzed. Hemodynamic parameters of the PCA were measured by transcranial color-coded sonography. We classified the range of ischemic lesions into 3 grades and perfusion levels into 3 grades according to computed tomography (CT) results. PCA steno-occlusion and leptomeningeal collaterals were confirmed by digital subtraction angiography. Ultrasonographic parameters in the PCA were compared with these radiographic findings. RESULTS The velocity in the involved PCA (mean flow velocity [MFV] median, 42.00 [range, 34.50-58.00] cm/s) was significantly lower than that in the normal PCA (MFV median, 95.00 [range, 76.50-119.50] cm/s) (P < .001). The velocity in the PCA increased significantly as the leptomeningeal collateral stage advanced (MFV stage 1: median, 38.50 [range, 29.75-63.50] cm/s; stage 2: median, 55.00 [range, 44.00-96.00] cm/s; stage 3: median, 94.00 [range, 54.00-118.25] cm/s; stage 4: median, 85.50 [range, 70.50-117.75] cm/s, respectively) (P < .05). Decreased PCA velocities were associated with a larger ischemic area on CT (P ≤ .001). PCA velocity had no correlation with CT perfusion level of the temporal and frontal lobes. PCA velocity had significant correlations with perfusion level in the occipital (P < .001) and parietal lobes (P < .05). CONCLUSIONS Our results suggest ischemic lesion patterns (as demonstrated on CT imaging) are associated with PCA velocity measurements in the advanced stage of MMD. Thus, monitoring PCA velocity in patients with advanced MMD may provide additional information to assist in managing these patients.
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Affiliation(s)
- Jing-Zhe Wang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Le-Bao Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ya-Hui Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jin-Xiu Cai
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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14
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15
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Kimiwada T, Hayashi T, Shirane R, Tominaga T. Posterior cerebral artery stenosis and posterior circulation revascularization surgery in pediatric patients with moyamoya disease. J Neurosurg Pediatr 2018; 21:632-638. [PMID: 29624146 DOI: 10.3171/2018.1.peds17367] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Some pediatric patients with moyamoya disease (MMD) present with posterior cerebral artery (PCA) stenosis before and after anterior circulation revascularization surgery and require posterior circulation revascularization surgery. This study evaluated the factors associated with PCA stenosis and assessed the efficacy of posterior circulation revascularization surgery, including occipital artery (OA)-PCA bypass, in pediatric patients with MMD. METHODS The presence of PCA stenosis before and after anterior circulation revascularization surgery and its clinical characteristics were investigated in 62 pediatric patients (< 16 years of age) with MMD. RESULTS Twenty-three pediatric patients (37%) with MMD presented with PCA stenosis at the time of the initial diagnosis. A strong correlation between the presence of infarction and PCA stenosis before anterior revascularization was observed (p < 0.001). In addition, progressive PCA stenosis was observed in 12 patients (19.4%) after anterior revascularization. The presence of infarction and a younger age at the time of initial diagnosis were risk factors for progressive PCA stenosis after anterior revascularization (p < 0.001 and p = 0.002, respectively). Posterior circulation revascularization surgery, including OA-PCA bypass, was performed in 9 of the 12 patients with progressive PCA stenosis, all of whom showed symptomatic and/or radiological improvement. CONCLUSIONS PCA stenosis is an important clinical factor related to poor prognosis in pediatric MMD. One should be aware of the possibility of progressive PCA stenosis during the postoperative follow-up period and consider performing posterior circulation revascularization surgery.
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Affiliation(s)
| | | | - Reizo Shirane
- 1Department of Neurosurgery, Miyagi Children's Hospital
| | - Teiji Tominaga
- 3Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Difference in Cerebral Circulation Time between Subtypes of Moyamoya Disease and Moyamoya Syndrome. Sci Rep 2017; 7:2587. [PMID: 28566764 PMCID: PMC5451479 DOI: 10.1038/s41598-017-02588-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/12/2017] [Indexed: 11/16/2022] Open
Abstract
In this study, we evaluated the differences in hemodynamics between hemorrhagic and non-hemorrhagic moyamoya disease (MMD) and moyamoya syndrome (MMS) by measuring cerebral circulation time (CCT). This case-control study included 136 patients with MMD or MMS diagnosed between April 2015 and July 2016 at Beijing Tian Tan Hospital. Each hemisphere was analyzed separately. The difference in clinical, radiological characteristics and CCT between subtypes of MMD and MMS were analyzed statistically. The results showed that total CCT between hemorrhagic and non-hemorrhagic sides was not statistically different (16.55 s vs. 16.06 s, P = 0.562). The cerebral filling circulation time (CFCT) of hemorrhagic sides was significantly shorter than that of non-hemorrhagic sides (4.52 s vs. 5.41 s, P < 0.001), and the cerebral venous circulation time (CVCT) of hemorrhagic sides was significantly longer than that of non-hemorrhagic sides (12.02 s, vs. 10.64 s, P < 0.001). The ratio of CFCT to CVCT (F-V ratio) was inversely correlated with the possibility of hemorrhagic stroke. Therefore, we conclude that the rapid filling and poor venous drainage of cerebral circulation are likely risk factors of hemorrhagic stroke secondary to MMD or MMS. The F-V ratio can be used to identify individuals at high risk of hemorrhagic stroke.
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Sajja A, Tsering D, Mooser AC, DeFreitas TA, Carpenter J, Magge SN. Patient With Severe Moyamoya Disease Who Presents With Acute Cortical Blindness. Stroke 2017; 48:e126-e129. [PMID: 28411258 DOI: 10.1161/strokeaha.116.015548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Aparna Sajja
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Deki Tsering
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Annie C Mooser
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Tiffani A DeFreitas
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Jessica Carpenter
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.)
| | - Suresh N Magge
- From the Department of Neurology (J.C.), Department of Neurological Surgery (S.N.M.), and Department of Pediatrics (J.C., S.N.M.), George Washington University School of Medicine and Health Sciences, Washington, DC (A.S.); Division of Neurosurgery (D.T., S.N.M.), Division of Anesthesiology (T.A.D.), and Department of Neurology (J.C.), Children's National Health System, Washington, DC; and Department of Surgery, St. Louis University, MO (A.C.M.).
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Verma R, Panwar A, Nagar K. Moyamoya disease involving anterior and posterior circulation. J Pediatr Neurosci 2017; 11:382-383. [PMID: 28217173 PMCID: PMC5314864 DOI: 10.4103/1817-1745.199470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rajesh Verma
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajay Panwar
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Kamal Nagar
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Tan C, Duan R, Ye X, Zhang D, Wang R. Posterior Circulation Moyamoya Disease versus Primitive Vertebral-Basilar Artery System Moyamoya Disease: New Classification of Moyamoya Disease from the Perspective of Embryology. World Neurosurg 2016; 96:222-229. [DOI: 10.1016/j.wneu.2016.08.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/20/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
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20
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Konieczny MJ, Ri SJ, Georgiadis JR. Omental Approach to Functional Recovery After Cerebrovascular Disease. World Neurosurg 2015; 87:406-16. [PMID: 26493716 DOI: 10.1016/j.wneu.2015.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To review and synthesize the clinical literature regarding risks and benefits of omentum transplantation and transposition surgery in patients with ischemic stroke of other etiology (non-MMD) and Moyamoya disease (MMD), and to evaluate the evidence for biological underpinnings of the presumed physiologic effects of omentum transplantation and transposition on vascularization of brain parenchyma. METHODS Articles were searched on scientific databases using predefined key terms. Data abstraction was based on the clinical course as reported in the articles. For further analysis, patients were divided into groups according to their diagnosis (MMD or non-MMD). Descriptive statistics were computed for better integration of the results. RESULTS The final literature review contained 15 articles (11 case series, 4 single case studies) with data on 93 patients (29 non-MMD, 64 MMD). At post-assessment 56% of patients showed substantial gains in functional domains (24% in the non-MMD group, 71% in the MMD group) and 92% demonstrated improvements of cerebral vascularization (55% in the non-MMD group, 98% in the MMD group). Differences in improvement became apparent with regard to the initial symptomatology wherein transient ischemic attacks were related to superior recovery rates and language pathologies showed least improvement. CONCLUSIONS Surgical revascularization using omental tissue has shown good success rates, particularly for recurrent transient ischemic attacks and prevention of further strokes and should be considered as treatment option for selected patients. Experimental data on the physiologic basis for postoperative improvement delivered convincing evidence for its arteriogenic potential and recent developments in omental stem cell research suggest a role in recovery from long-standing neurological deficits.
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Affiliation(s)
- Marek J Konieczny
- Department of Molecular Neurobiology, Graduate School of Behavioural and Cognitive Neurosciences, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands; Charite-Universitätsmedizin Berlin, Department of Experimental Neurology, Campus Benjamin Franklin, Berlin, Germany.
| | - Song-Jin Ri
- Charite-Universitätsmedizin Berlin, Department of Experimental Neurology, Campus Benjamin Franklin, Berlin, Germany
| | - Janniko R Georgiadis
- Department of Neuroscience, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
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21
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Piao J, Wu W, Yang Z, Yu J. Research Progress of Moyamoya Disease in Children. Int J Med Sci 2015; 12:566-75. [PMID: 26180513 PMCID: PMC4502061 DOI: 10.7150/ijms.11719] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 06/02/2015] [Indexed: 12/03/2022] Open
Abstract
During the onset of Moyamoya disease (MMD), progressive occlusion occurs at the end of the intracranial internal carotid artery, and compensatory net-like abnormal vessels develop in the skull base, generating the corresponding clinical symptoms. MMD can affect both children and adults, but MMD in pediatric patients exhibits distinct clinical features, and the treatment prognoses are different from adult patients. Children are the group at highest risk for MMD. In children, the disease mainly manifests as ischemia, while bleeding is the primary symptom in adults. The pathogenesis of MMD in children is still unknown, and some factors are distinct from those in adults. MMD in children could result in progressive, irreversible nerve functional impairment, and an earlier the onset corresponds to a worse prognosis. Therefore, active treatment at an early stage is highly recommended. The treatment methods for MMD in children mainly include indirect and direct surgeries. Indirect surgeries mainly include multiple burr-hole surgery (MBHS), encephalomyosynangiosis (EMS), and encephaloduroarteriosynangiosis (EDAS); direct surgeries mainly include intra- and extracranial vascular reconstructions that primarily consist of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. Indirect surgery, as a treatment for MMD in children, has shown a certain level of efficacy. However, a standard treatment approach should combine both indirect and direct procedures. Compared to MMD in adults, the treatment and prognosis of MMD in children has higher clinical significance. If the treatment is adequate, a satisfactory outcome is often achieved.
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Affiliation(s)
| | | | | | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China
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Lee JY, Kim SK, Phi JH, Wang KC. Posterior Cerebral Artery Insufficiency in Pediatric Moyamoya Disease. J Korean Neurosurg Soc 2015; 57:436-9. [PMID: 26180612 PMCID: PMC4502241 DOI: 10.3340/jkns.2015.57.6.436] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 04/22/2015] [Accepted: 05/18/2015] [Indexed: 11/27/2022] Open
Abstract
The majority of clinical studies on moyamoya disease (MMD) have focused on anterior circulation. The disease involvement of posterior circulation in MMD, mainly in the posterior cerebral artery (PCA), has been mentioned since the early 1980s, and it has been repeatedly emphasized as one of the most important factors related to poor prognosis in MMD. However, its clinical features and outcome have only been elucidated during the last few years. In this review, the angiographic definition of PCA stenosis is summarized. The clinical features are elucidated as being either early-onset or delayed-onset, according to the time of PCA stenosis diagnosis in reference to the anterior circulation revascularization surgeries. The surgical strategy and hypothesis on the mechanism of PCA stenosis is also briefly mentioned. It appears that some MMD patients may show PCA stenosis during the early or late course of the disease and that the presenting symptoms may vary. Because the hemodynamic compromise caused by PCA stenosis may respond well to surgical treatment, clinicians should be aware of the condition, especially during follow-up of MMD patients.
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Affiliation(s)
- Ji Yeoun Lee
- Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea. ; Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu-Chang Wang
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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Mugikura S, Takahashi S. Letters to the Editor: posterior cerebral artery involvement and pediatric moyamoya diseaes. J Neurosurg Pediatr 2014; 14:434-5. [PMID: 25084087 DOI: 10.3171/2014.4.peds14185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Shunji Mugikura
- Tohoku University, Graduate School of Medicine, Sendai, Japan
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Borah P, Sharma V, Basumatary LJ, Das M, Goswami M, Kayal AK. Varied presentations of moyamoya disease in a tertiary care hospital of north-east India. Ann Indian Acad Neurol 2014; 17:317-20. [PMID: 25221403 PMCID: PMC4162020 DOI: 10.4103/0972-2327.138518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/12/2014] [Accepted: 02/24/2014] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Moyamoya disease is a chronic progressive cerebrovascular disorder, characterized by stenosis or occlusion of bilateral internal carotid arteries (ICAs), anterior cerebral arteries (ACAs) and middle cerebral arteries (MCAs), accompanied by a collateral network of vessels formed at the base of the brain. Ischemia and intracranial hemorrhage are the common typical manifestations. However moyamoya disease has been associated with atypical presentations like headache, seizures and involuntary movements. Although frequently reported from Asian countries like Japan, China and Korea, only few studies reported on clinical manifestations of moyamoya disease from India. OBJECTIVES To study the varied presentations of moyamoya disease in a tertiary care hospital of north-east India. MATERIAL AND METHODS Relevant investigations were done to rule out other causes of moyamoya syndrome. RESULTS We report 6 cases of moyamoya disease with varied presentations from a tertiary care referral government hospital. Case 1, 2 and 6 presented with alternating hemiparesis. Case 3 had amaurosis fugax. Case 4 had history suggestive of ischemic stroke and presented with hemichorea. Case 4 had focal seizure as the only manifestation. Cases 4 and 5 notably had stenosis of posterior cerebral artery (PCA) in addition to stenosis of bilateral ICAs, ACAs and MCAs. CONCLUSION Owing to its low incidence in India, moyamoya disease is easily overlooked as a possible diagnosis. However, because of its progressive nature, it is imperative to diagnose this disease early and offer surgical treatment to the patients.
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Affiliation(s)
- Papori Borah
- Department of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Vikas Sharma
- Department of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | | | - Marami Das
- Associate Professor of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Munindra Goswami
- Professor of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Ashok K Kayal
- Professor and Head of the Department of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India
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Funaki T, Takahashi JC, Takagi Y, Yoshida K, Araki Y, Kikuchi T, Kataoka H, Iihara K, Miyamoto S. Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease. J Neurosurg Pediatr 2013; 12:626-32. [PMID: 24138143 DOI: 10.3171/2013.9.peds13111] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In the study of pediatric moyamoya disease, information on long-term social outcomes and risk factors for unfavorable social outcomes remains insufficient. The authors analyzed the long-term results of surgical revascularization for pediatric patients with moyamoya disease to determine whether the involvement of a stenoocclusive lesion in the posterior cerebral artery (PCA), relatively common in pediatric moyamoya disease, represents an underlying predictor for unfavorable social outcomes. METHODS Prospectively collected data on 61 consecutive patients with moyamoya disease who had undergone combined bypass surgery were analyzed. Neuroradiological features and other baseline clinical factors were incorporated into univariate and multivariate analyses to determine any association with an unfavorable social outcome, defined as difficulty attending regular school or obtaining regular employment. RESULTS Posterior cerebral artery involvement detected by angiography on admission was noted in 22 (36.1%) of the 61 patients. Follow-up data were acquired in 56 patients (91.8%), and the mean follow-up period was 15.8 years. While transient ischemic attacks were eliminated in 52 (92.9%) of these 56 patients after surgery, and late-onset ischemic stroke was observed in only 1 patient during the follow-up period, 10 (17.9%) experienced an unfavorable social outcome. Although younger age at onset, longer duration between onset and surgery, infarction present on preoperative neuroradiological images, and PCA involvement had been identified as risk factors for an unfavorable social outcome in univariate analysis, only infarction present on preoperative images and PCA involvement remained statistically significant after multivariate adjustment. CONCLUSIONS Posterior cerebral artery involvement can be considered one of the underlying risk factors for unfavorable social outcome and should be studied further to improve social outcome in pediatric moyamoya disease.
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Affiliation(s)
- Takeshi Funaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto
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Hishikawa T, Tokunaga K, Sugiu K, Date I. Assessment of the difference in posterior circulation involvement between pediatric and adult patients with moyamoya disease. J Neurosurg 2013; 119:961-5. [DOI: 10.3171/2013.6.jns122099] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
There is no description of the change in the posterior cerebral artery (PCA) in the diagnostic criteria of moyamoya disease (MMD). However, PCAs are often involved in the clinical setting, and an understanding of the significance of PCA lesions is therefore of great importance when evaluating the disease progression and predicting prognosis. The aim of this study was to assess the difference in posterior circulation involvement in pediatric and adult patients with MMD.
Methods
The records of 120 consecutive patients with MMD were reviewed. The clinical manifestations at diagnosis were evaluated on the basis of symptoms and CT and MRI findings. The degree of steno-occlusive internal carotid artery (ICA) lesions and the existence of steno-occlusive PCA lesions were evaluated by observing a total of 240 ICAs and PCAs on angiography. Angiographic correlation between anterior and posterior circulation was assessed in pediatric and adult patients with MMD.
Results
Seventeen (26%) of 66 pediatric patients and 18 (33%) of 54 adult patients exhibited steno-occlusive PCA lesions. There was no significant difference in the prevalence of PCA lesions between pediatric and adult patients with MMD (p = 0.36). The prevalence of infarction in pediatric and adult patients with PCA involvement was significantly higher than that in pediatric and adult patients without PCA involvement (p = 0.0003 and p = 0.003, respectively). There was no significant difference in the distribution of infarction areas between pediatric and adult patients with PCA involvement (p = 0.62). On the basis of the staging system used, steno-occlusive lesions in ICAs ipsilateral to PCAs with lesions were in significantly advanced stages compared with lesions in ICAs ipsilateral to PCAs without lesions in both pediatric and adult cases (p < 0.0001 and p = 0.0008, respectively). Pediatric patients had less advanced steno-occlusive lesions in ICAs ipsilateral to PCAs with lesions compared with adults (p < 0.05).
Conclusions
The clinical significance of posterior circulation involvement in MMD was similar between pediatric and adult patients. The only significant difference was that less advanced ICA lesions could complicate posterior circulation involvement in pediatric patients.
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Kim HS, Lee SW, Sung SK, Seo EK. Terson syndrome caused by intraventricular hemorrhage associated with moyamoya disease. J Korean Neurosurg Soc 2012; 51:367-9. [PMID: 22949967 PMCID: PMC3424178 DOI: 10.3340/jkns.2012.51.6.367] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 04/20/2012] [Accepted: 06/12/2012] [Indexed: 11/27/2022] Open
Abstract
Terson syndrome was originally used to describe a vitreous hemorrhage arising from aneurysmal subrarachnoid hemorrhage. Terson syndrome can be caused by intracranial hemorrhage, subdural or epidural hematoma and severe brain injury but is extremely rare in intraventricular hemorrhage associated with moyamoya disease. A 41-year-old man presented with left visual disturbance. He had a history of intraventicular hemorrhage associated with moyamoya disease three months prior to admission. At that time he was in comatose mentality. Ophthalmologic examination at our hospital detected a vitreous hemorrhage in his left eye, with right eye remaining normal. Vitrectomy with epiretinal membrane removal was performed. After operation his left visual acuity was recovered. Careful ophthalmologic examination is mandatory in patients with hemorrhagic moyamoya disease.
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Affiliation(s)
- Ho Sang Kim
- Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
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Currie S, Raghavan A, Batty R, Connolly DJA, Griffiths PD. Childhood moyamoya disease and moyamoya syndrome: a pictorial review. Pediatr Neurol 2011; 44:401-13. [PMID: 21555050 DOI: 10.1016/j.pediatrneurol.2011.02.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 11/24/2010] [Accepted: 02/10/2011] [Indexed: 10/18/2022]
Abstract
Moyamoya disease is an uncommon chronic cerebrovasculopathy, characterized by progressive stenosis of the terminal portion of the internal carotid artery and its main branches, in association with the development of compensatory collateral vessels at the base of the brain. The etiology is unknown, and was originally considered exclusive to East Asia, with particular prevalence in Japan. Moyamoya disease is increasingly diagnosed throughout the world, and represents an important cause of childhood stroke in Western countries. In some cases, similar angiographic features are evident in children with other medical conditions, such as sickle cell disease and Down syndrome. In these instances, the term "moyamoya syndrome" is used. Diagnosing the vasculopathy, excluding possible associated conditions, and planning treatment and follow-up imaging comprise important aspects of clinical management. We review the key imaging features of childhood moyamoya disease and syndrome, present examples of its associations, and discuss new neuroradiologic methods that may be useful in management.
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Affiliation(s)
- Stuart Currie
- Leeds and West Yorkshire Radiology Academy, Leeds General Infirmary, Leeds University Teaching Hospitals, National Health Service Trust, Leeds, United Kingdom.
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Cho A, Kim SY. A Case of Moyamoya Disease Initially Presenting as Anterior Ischemic Optic Neuropathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.7.887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Aran Cho
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Seoul, Korea
| | - So Young Kim
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Huang APH, Tu YK. Progressive PCA Steno-Occlusive Changes After Revascularization for Moyamoya Disease: A Neglected Phenomenon. Neurosurgery 2010; 67:E1865-6; author reply E1866. [DOI: 10.1227/neu.0b013e3181f36022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
PURPOSE Moyamoya disease, a rare cause of pediatric stroke, is a cerebrovascular occlusive disorder resulting from progressive stenosis of the distal intracranial carotid arteries and their proximal branches. In response to brain ischemia, there is the development of basal collateral vessels, which give rise to the characteristic angiographic appearance of moyamoya. If left untreated, the disease can result in overwhelming permanent neurological and cognitive deficits. METHODS Whereas moyamoya disease refers to the idiopathic form, moyamoya syndrome refers to the condition in which children with moyamoya also have a recognized clinical disorder. As opposed to adults who typically present in the setting of intracranial hemorrhage, the classic pediatric presentation is recurrent transient ischemic attacks and/or completed ischemic strokes. RESULTS Surgical revascularization, including direct and indirect techniques, remains the mainstay of treatment, and has been shown to improve long-term outcome in children with moyamoya. CONCLUSION The authors discuss the diagnosis and treatment of moyamoya disease in the pediatric population.
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Imaging in childhood arterial ischaemic stroke. Neuroradiology 2010; 52:577-89. [PMID: 20445969 DOI: 10.1007/s00234-010-0704-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022]
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Hayashi K, Ushijima R, Matsuo T, Kitagawa N, Suyama K, Nagata I. The 150th anniversary of Nagasaki University School of Medicine: recovery from the atomic disaster and evolution of the department of neurosurgery. Neurosurgery 2009; 65:595-9; discussion 599-600. [PMID: 19687706 DOI: 10.1227/01.neu.0000350872.53258.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
NAGASAKI IS LOCATED on the western edge of Japan, closer to the Asian continent. Because of this geographical proximity, Nagasaki became a gateway for the introduction of continental culture and civilization to Japan. After the port of Nagasaki was opened for trade with the Portuguese in 1571, Nagasaki had a central role in cultural exchange with the West and China until the latter half of the 19th century. As a result of the political situation, students came to Nagasaki from all over Japan to obtain information on Western science, especially in medicine, turning Nagasaki into a hub for modern academic studies. The first medical facility in Japan educating doctors in the Western style was founded in Nagasaki in 1857. Despite the tragedy of World War II, the medical school arose again. More than 10 000 physicians have completed their studies at the medical school since its founding. The Department of Neurosurgery at Nagasaki University had its origins within the Second Department of Surgery and became an independent department in 1973. The post of professor was assumed by Kazuo Mori and succeeded in 1991 by Shobu Shibata and in 2003 by Izumi Nagata, who holds the post at the time of this writing. Neurosurgery is dynamic and constantly changing at Nagasaki University with work in progress on technological, diagnostic, and surgical innovations that permit the treatment of highly complex cases. In 2007, the 150th anniversary of the founding of Nagasaki University School of Medicine was celebrated with a number of commemorative events.
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Affiliation(s)
- Kentaro Hayashi
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan.
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Abstract
Moyamoya disease, a known cause of pediatric stroke, is an unremitting cerebrovascular occlusive disorder of unknown etiology that can lead to devastating, permanent neurological disability if left untreated. It is characterized by progressive stenosis of the intracranial internal carotid arteries and their distal branches and the nearly simultaneous appearance of basal arterial collateral vessels that vascularize hypoperfused brain distal to the occluded vessels. Moyamoya disease may be idiopathic or may occur in association with other syndromes. Most children with moyamoya disease present with recurrent transient ischemic attacks or strokes. Although there is no definitive medical treatment, numerous direct and indirect revascularization procedures have been used to improve the compromised cerebral circulation, with outcomes varying according to procedure type. Such techniques improve the long-term outcome of patients with both idiopathic and syndrome-associated moyamoya disease. This review provides a comprehensive discussion of moyamoya disease in children, with an emphasis on the most effective surgical treatment options.
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Affiliation(s)
- Jodi L Smith
- Division of Pediatric Neurosurgery, Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Hayashi T, Shirane R, Tominaga T. ADDITIONAL SURGERY FOR POSTOPERATIVE ISCHEMIC SYMPTOMS IN PATIENTS WITH MOYAMOYA DISEASE. Neurosurgery 2009; 64:E195-6; discussion E196. [DOI: 10.1227/01.neu.0000336311.60660.26] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
In patients with moyamoya disease, surgery to revascularize the ischemic brain is a recommended treatment. However, there are a few patients who require additional revascularization surgery because of progression of the disease. Even patients who show no postoperative ischemic symptoms at first may experience late deterioration. We performed additional surgery for such lesions using occipital artery (OA)–posterior cerebral artery (PCA) bypass with indirect revascularization. The efficacy of the procedure is reported.
METHODS
We treated 3 patients with moyamoya disease who showed a transient ischemic attack after revascularization surgery. Three female patients, ranging in age from 6.0 to 35.2 years (mean age, 23.8 years) at the time of surgery, with ischemic symptoms (leg monoparesis in 2, visual impairment in 1) underwent the additional revascularization procedure. Preoperatively, all patients underwent indirect and/or direct revascularization surgery for initial treatment. All patients showed progression of the disease, especially in the PCA. OA–PCA bypass with encephalogaleodurosynangiosis and burr hole surgery were performed for postoperative ischemic symptoms.
RESULTS
All patients showed clinical and radiological improvement. The transient ischemic attack was improved in all 3 patients. They did not complain of transient ischemic attack in the recent follow-up period. Follow-up magnetic resonance imaging showed no additional cerebral infarction. Magnetic resonance angiography showed widening of the OA and development of peripheral collateral vessels. Postoperative single-photon emission computed tomographic studies showed marked increase of uptake in both anterior cerebral artery and PCA territories. Cerebral vasodilatory capacity evaluated by an acetazolamide test also showed marked improvement. One patient showed postoperative cerebral edema as a result of focal cerebral hyperperfusion.
CONCLUSION
OA–PCA anastomosis with indirect revascularization was effective for postoperative ischemia that showed symptoms in the anterior cerebral artery and PCA territories as a result of progression of a PCA lesion.
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Affiliation(s)
- Toshiaki Hayashi
- Department of Neurosurgery, Miyagi Children's Hospital, Sendai, Japan
| | - Reizo Shirane
- Department of Neurosurgery, Miyagi Children's Hospital, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Abstract
Moyamoya disease is an uncommon cerebrovascular disease that is characterised by progressive stenosis of the terminal portion of the internal carotid artery and its main branches. The disease is associated with the development of dilated, fragile collateral vessels at the base of the brain, which are termed moyamoya vessels. The incidence of moyamoya disease is high in east Asia, and familial forms account for about 15% of patients with this disease. Moyamoya disease has several unique clinical features, which include two peaks of age distribution at 5 years and at about 40 years. Most paediatric patients have ischaemic attacks, whereas adult patients can have ischaemic attacks, intracranial bleeding, or both. Extracranial-intracranial arterial bypass, including anastomosis of the superficial temporal artery to the middle cerebral artery and indirect bypass, can help prevent further ischaemic attacks, although the beneficial effect on haemorrhagic stroke is still not clear. In this Review, we summarise the epidemiology, aetiology, clinical features, diagnosis, surgical treatment, and outcomes of moyamoya disease. Recent updates and future perspectives for moyamoya disease will also be discussed.
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Affiliation(s)
- Satoshi Kuroda
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan.
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Czabanka M, Peña-Tapia P, Schubert GA, Woitzik J, Vajkoczy P, Schmiedek P. Characterization of cortical microvascularization in adult moyamoya disease. Stroke 2008; 39:1703-9. [PMID: 18403740 DOI: 10.1161/strokeaha.107.501759] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Increased cortical microvascularization has been proposed to be a Moyamoya disease (MMD)-specific characteristic. It was the aim of our study to characterize the anatomic pattern and microhemodynamics of cortical microvascularization in MMD. METHODS Intraoperative indocyanine green videoangiography was performed in 16 adult MMD patients, 15 patients with atherosclerotic cerebrovascular disease (ACVD), and 10 control patients. Cortical microvascularization and microvascular hemodynamics were categorized and analyzed according to anatomic and functional indocyanine green angiographic aspects. Anatomic analysis included microvascular density, microvascular diameter, and microvascular surface per analyzed area. Microhemodynamic analysis included microvascular transit time, arterial microvascular transit time, and venous microvascular transit time. RESULTS Microvascular density and diameter were significantly increased in MMD patients (1.8+/-0.2 mm/mm(2) and 0.24+/-0.03 mm, respectively) compared with those in ACVD patients (1.5+/-0.2 mm/mm(2) and 0.20+/-0.02 mm, respectively) and controls (1.5+/-0.1 mm/mm(2) and 0.19+/-0.03 mm, respectively). This resulted in significantly increased microvascular surface per analyzed area in MMD (67+/-13%) vs ACVD patients (47+/-7%) and controls (45+/-6%). Anatomic changes were paralleled by significantly increased microvascular and arterial microvascular transit times in MMD patients (11.55+/-3.50 and 6.79+/-2.96 seconds, respectively) compared with those in ACVD patients (8.13+/-1.78 and 4.34+/-1.30 seconds, respectively) and controls (8.04+/-2.16 and 4.50+/-1.87 seconds, respectively). CONCLUSIONS Cortical microvascularization in MMD is characterized by significantly increased microvascular density and microvascular diameter, leading to increased microvascular surface. These anatomic alterations are accompanied by prolonged microvascular hemodynamics. These observations might represent an MMD-specific compensation mechanism for impaired cerebral blood flow.
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Affiliation(s)
- Marcus Czabanka
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Am Augustenburgerplatz 1, 13353 Berlin, Germany.
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Kuroda S, Ishikawa T, Houkin K, Nanba R, Hokari M, Iwasaki Y. Incidence and Clinical Features of Disease Progression in Adult Moyamoya Disease. Stroke 2005; 36:2148-53. [PMID: 16179571 DOI: 10.1161/01.str.0000182256.32489.99] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The progression of occlusive lesions in the major intracranial arteries was believed to be very rare in adult patients with moyamoya disease. The present study aims to clarify the incidence and clinical features of disease progression in adult moyamoya disease.
Methods—
For the past 15 years, 120 adult Japanese patients were diagnosed with moyamoya disease. Of these, 63 patients were enrolled in this historical prospective cohort study on a total of 86 nonoperated hemispheres. All were followed up with a mean period of 73.6 months. MRI and magnetic resonance angiography were repeated every 6 to 12 months, and cerebral angiography was performed when disease progression was suspected on MRI and magnetic resonance angiography.
Results—
Disease progression occurred in 15 of 86 nonoperated hemispheres (17.4% per hemisphere) or in 15 of 63 patients (23.8% per patient) during the follow-up period. Occlusive arterial lesions progressed in both anterior and posterior circulations, in both symptomatic and asymptomatic patients, and in both bilateral and unilateral types. Eight of 15 patients developed ischemic or hemorrhagic events in relation to disease progression. Multivariate analysis revealed that the odds ratio conferred by a male patient was 0.20 (95% CI, 0.04 to 0.97).
Conclusions—
The incidence of disease progression in adult moyamoya disease is much higher than recognized before, and female patients may be at higher risk for it than male patients. Careful follow-up would be essential to prevent additional stroke occurrence in medically treated adult patients with moyamoya disease, even if they are asymptomatic or are diagnosed as having unilateral moyamoya disease.
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Affiliation(s)
- Satoshi Kuroda
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Matsumoto H, Kohno K, Inoue A, Mitsuhara T, Kohno K, Takechi A, Takeda T, Sasaki U. Pediatric Moyamoya Disease treated by Combined Extensive Indirect Revascularization Surgery 8 years after Initial Encephalo-Duro-Arterio-Synangiosis (EDAS) and Encephalo-Galeo-Synangiosis (EGS) : A Case Report. ACTA ACUST UNITED AC 2003. [DOI: 10.7887/jcns.12.539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Kanehisa Kohno
- Department of Neurosurgery, Ehime Prefectural Central Hospital
| | - Akihiro Inoue
- Department of Neurosurgery, Ehime Prefectural Central Hospital
| | | | - Keiji Kohno
- Department of Neurosurgery, Ehime Prefectural Central Hospital
| | - Akihiko Takechi
- Department of Neurosurgery, Ehime Prefectural Central Hospital
| | - Tetsuji Takeda
- Department of Neurosurgery, Ehime Prefectural Central Hospital
| | - Ushio Sasaki
- Department of Neurosurgery, Ehime Prefectural Central Hospital
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Arakawa Y, Goto Y, Ishii A, Ueno Y, Kikuta K, Yoshizumi H, Katsuta H, Kenmochi S, Yamagata S. Terson syndrome caused by ventricular hemorrhage associated with moyamoya disease--case report. Neurol Med Chir (Tokyo) 2000; 40:480-3. [PMID: 11021082 DOI: 10.2176/nmc.40.480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 24-year-old female presented with Terson syndrome secondary to bilateral ventricular hemorrhage as a complication of moyamoya disease. Ophthalmoscopy and magnetic resonance imaging clearly demonstrated vitreous hemorrhage in the left eye globe. Various visual symptoms are associated with moyamoya disease, almost all of which result from ischemic lesions in the visual cortex and optic pathways. In this case, the visual disturbance was caused by Terson syndrome secondary to ventricular hemorrhage. Close ophthalmological and radiological evaluation is mandatory even in patients with moyamoya disease and hemorrhagic manifestation located in the intracerebral, subarachnoid, or intraventricular space.
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Affiliation(s)
- Y Arakawa
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama
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44
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Kohno K, Shoda D, Furuta S, Ueda T, Watanabe H, Ohta S, Kumon Y, Sakaki S. Childhood Moyamoya Disease treated by One-staged Extensive Indirect Vascular Reconstructive Surgery: A Case Report. ACTA ACUST UNITED AC 1997. [DOI: 10.7887/jcns.6.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kanehisa Kohno
- Department of Neurosurgery, Ehime University School of Medicine
| | - Daisuke Shoda
- Department of Neurosurgery, Ehime University School of Medicine
| | - Shigeru Furuta
- Department of Neurosurgery, Ehime University School of Medicine
| | - Toshihiro Ueda
- Department of Neurosurgery, Ehime University School of Medicine
| | | | - Shinsuke Ohta
- Department of Neurosurgery, Ehime University School of Medicine
| | - Yoshiaki Kumon
- Department of Neurosurgery, Ehime University School of Medicine
| | - Saburo Sakaki
- Department of Neurosurgery, Ehime University School of Medicine
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Touho H, Karasawa J, Tenjin H, Ueda S. Omental transplantation using a superficial temporal artery previously used for encephaloduroarteriosynangiosis. SURGICAL NEUROLOGY 1996; 45:550-8; discussion 558-9. [PMID: 8638241 DOI: 10.1016/0090-3019(95)00459-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Childhood moyamoya disease is a chronically progressive cerebrovascular occlusive disease affecting the territories of the anterior, middle, and posterior cerebral arteries. Surgery used in treatment of moyamoya disease to vascularize the brain include direct and indirect anastomoses. METHODS Intracranial omental transplantation (OMT) was performed using a branch of the superficial temporal artery (STA) that had been used previously for encephaloduroarteriosynangiosis (EDAS) in five children with moyamoya disease. All five children continued to have paraparetic transient ischemic attacks (TIAs), urinary incontinence, and/or progressive mental retardation even after EDAS and/or STA-middle cerebral artery (MCA) anastomosis and encephalomyosynangiosis (EMS) to the territory of the MCA. Previously performed EDAS gave insufficient collaterals to the territory of the MCA in four of the five patients and sufficient collaterals to the territory of the MCA in the remaining patient. OMT was performed after stripping of a branch of the STA used in EDAS that gave insufficient collaterals to the brain in the former four patients; and the latter patient was performed using a parietal branch of the STA distal to the distal burr hole drilled in the previous EDAS. RESULTS OMT resulted in marked improvement in neurologic conditions in all five patients. Four of the five patients suffered no TIAs postoperatively, while the remaining patient still had TIAs but at a markedly decreased frequency. CONCLUSIONS In summary, OMT using a branch of the STA used in previously performed EDAS is required for patients with moyamoya disease who continue to manifest paraparesis, urinary incontinence, and/or progressive mental retardation even after multiple EDAS.
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Affiliation(s)
- H Touho
- Department of Neurosurgery, Osaka Neurological Institute, Japan
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Barrall JL, Summers CG. Ocular ischemic syndrome in a child with moyamoya disease and neurofibromatosis. Surv Ophthalmol 1996; 40:500-4. [PMID: 8724642 DOI: 10.1016/s0039-6257(96)82016-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Ocular ischemic syndrome is extremely rare in childhood. Patients with moyamoya disease may be particularly susceptible to the development of ocular ischemia due to the associated carotid occlusion. A 19-month-old boy presented with neurofibromatosis and signs of ocular ischemia. At 29 months of age, he developed dense right vitreous hemorrhage and eventually lost vision in that eye due to phthisis. At almost six years of age, he developed an acute hemiplegia and was then diagnosed with moyamoya disease. This rare instance of childhood ocular ischemia in conjunction with moyamoya disease and neurofibromatosis demonstrates the serious ocular and systemic sequelae of occlusive vascular disease.
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Affiliation(s)
- J L Barrall
- Department of Ophthalmology, University of Minnesota, Minneapolis, USA
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Touho H, Karasawa J, Ohnishi H. Cerebral revascularization using gracilis muscle transplantation for childhood moyamoya disease. SURGICAL NEUROLOGY 1995; 43:191-7; discussion 197-8. [PMID: 7892667 DOI: 10.1016/0090-3019(95)80133-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Omental transplantation is effective in the management of ischemia in the territories of the anterior and posterior cerebral arteries in childhood moyamoya disease. We introduced a surgical revascularization using gracilis muscle transplantation to these territories. METHODS Between January 1991 and May 1993, six children with moyamoya disease, between the age of 3 and 13 years, underwent gracilis muscle transplantation to the territory of either the anterior or the posterior cerebral artery. The mean period of follow-up after surgery was 15.2 months, with a range of 5 to 32 months. Three of the six patients had suffered from frequent transient visual disturbance and were treated with unilateral or bilateral gracilis muscle transplantation to the territory of the posterior cerebral artery. The other three patients had suffered from frequent transient paraparesis, mental retardation, and/or rectal and urinary incontinence, and were treated with gracilis muscle transplantation bilaterally to the territories of the anterior cerebral arteries. RESULTS All three patients with gracilis muscle transplantation unilaterally or bilaterally to the occipital lobes manifested complete disappearance of their symptoms. Two of the three patients with gracilis muscle transplantation bilaterally to the frontal lobes also manifested complete disappearance of their symptoms. The remaining patient who underwent the transplantation bilaterally to the frontal lobes, continued to have episodes of transient paraparesis, postsurgically, but the frequency of symptoms was markedly decreased. CONCLUSIONS Ischemia in the territories of the anterior and/or posterior cerebral arteries could be overcome with the use of gracilis muscle transplantation in childhood moyamoya disease.
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Affiliation(s)
- H Touho
- Department of Neurosurgery, Osaka Neurological Institute, Japan
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Abstract
OBJECTIVE To discuss the clinical features of moyamoya disease, the studies that aid in diagnosing this disorder, and the reported outcomes of surgical treatment. DESIGN We review the manifestations of moyamoya disease in children and adults and the recent reports of the various surgical procedures. MATERIAL AND METHODS Moyamoya disease is a chronic cerebrovascular disorder in which stenosis of the major arteries of the circle of Willis at the base of the skull progresses to occlusion. The diagnosis is based on the angiographic findings of the "puff of smoke" appearance of the abnormal capillary vessels at the base of the skull. Three surgical procedures are used to manage this disease: anastomosis of the superficial temporal artery to the middle cerebral artery, encephalomyosynangiosis, and encephaloduro-arteriosynangiosis. RESULTS In children with this disease, cerebral ischemic events, including strokes, occur. In adults, the fragile abnormal vessels can rupture and cause intracerebral hemorrhage. The mortality rate for adults is higher than that for children. Most published reports support the efficacy of surgical treatment in children but not in adults. CONCLUSIONS The natural history of moyamoya disease is poor; neurologic deterioration due to strokes and hemorrhage is progressive. Seizures and intellectual deterioration can occur.
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Affiliation(s)
- K Ueki
- Department of Neurologic Surgery, Mayo Clinic Rochester, Minnesota 55905
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Karasawa J, Touho H, Ohnishi H, Miyamoto S, Kikuchi H. Cerebral revascularization using omental transplantation for childhood moyamoya disease. J Neurosurg 1993; 79:192-6. [PMID: 8331399 DOI: 10.3171/jns.1993.79.2.0192] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Between January, 1986, and October, 1990, 30 children with moyamoya disease, aged from 2 to 17 years, underwent omental transplantation to either the anterior or the posterior cerebral artery territory. The mean follow-up period was 3.8 years, ranging from 1.6 to 6.4 years. Seventeen patients had symptoms of monoparesis, paraparesis, and/or urinary incontinence and were treated using unilateral or bilateral omental transplantation to the anterior cerebral artery territory. Eleven patients had visual symptoms and were treated with unilateral or bilateral omental transplantation to the posterior cerebral artery territory. Two patients had symptoms associated with both the anterior and the posterior cerebral arteries, and were treated with dual omental transplantations. All 19 patients treated with omental transplantation to the anterior cerebral artery and 11 (84.6%) of the 13 treated with omental transplantation to the posterior cerebral artery showed improvement in their neurological state. Patients with more collateral vessels via the omentum had more rapid and complete improvement in their neurological state. Patients with severe preoperative neurological deficits associated with the posterior cerebral artery had persistence of their symptoms.
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Affiliation(s)
- J Karasawa
- Department of Neurosurgery, Osaka Neurological Institute, Japan
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Yamada I, Matsushima Y, Suzuki S. Childhood moyamoya disease before and after encephalo-duro-arterio-synangiosis: an angiographic study. Neuroradiology 1992; 34:318-22. [PMID: 1528443 DOI: 10.1007/bf00588191] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Encephalo-duro-arterio-synangiosis (EDAS) is a new surgical operation for childhood moyamoya disease, and its effects have been studied by comparing pre- and postoperative angiograms in 27 patients. The development of collaterals from the external carotid arterial system into the territory of the middle cerebral artery was excellent in 16 of 54 cerebral hemispheres after EDAS, good in 25, and poor in 13. The development of collaterals after EDAS increased as the stenotic process in the internal carotid artery on preoperative angiograms increased except in the most advanced cases, where it seemed to decrease in comparison with the group with middle grade stenosis. After EDAS, not only the superficial temporal artery, but also the adjacent middle meningeal artery participated in forming collateral pathways. Furthermore, decrease of abnormal net-like vessels was observed when there was good to excellent development of collateral vessels. Stenotic lesions in the internal carotid and posterior cerebral arteries were often seen to progress, indicative of the rapidly progressive nature of childhood moyamoya disease. These results appear to suggest that EDAS should be performed as early as possible in childhood moyamoya disease before the occurrence of an irreversible ischaemic state and/or permanent neurological defects.
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Affiliation(s)
- I Yamada
- Department of Radiology, School of Medicine, Tokyo Medical and Dental University, Japan
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