Bypass Surgery for Adult-Onset Hemorrhagic Moyamoya Disease: Analysis Classified by Site of Initial Bleeding

Hirano, Yuko; Miyawaki, Satoru; Imai, Hideki; Hongo, Hiroki; Koizumi, Satoshi; Yajima, Hirohisa; Torazawa, Seiei; Ishigami, Daiichiro; Kiyofuji, Satoshi; Saito, Nobuhito

doi:10.1016/j.wneu.2023.07.130

Cited by 2 publications

(1 citation statement)

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“…In hemorrhagic MMD, rebleeding is a factor that significantly worsens the prognosis, and its prevention is a primary concern. The Japanese Adult Moyamoya trial, a multicenter, prospective, randomized controlled trial, demonstrated that bypass surgery effectively prevented rebleeding in patients with specific backgrounds [ 6 , 19 ]. The inclusion criteria for the study included age between 16 and 65 years and a modified Rankin scale score of 0 to 2, indicating independence.…”

Section: Discussionmentioning

confidence: 99%

Suzuki Stage VI Unilateral Moyamoya Disease Presenting With Massive Intraventricular Hemorrhage

Hirano,

Miyawaki,

Koike

et al. 2024

Cureus

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Moyamoya disease (MMD) is characterized by stenosis of the terminal portion of the internal carotid artery (ICA) and the development of collateral vessels. In late Suzuki stage MMD, ICA almost disappears, and the moyamoya vessels gradually regress. We report a case of late Suzuki stage unilateral MMD presenting with intraventricular hemorrhage. A 76-year-old woman who had previously been diagnosed with right ICA occlusive disease was referred to our hospital due to impaired consciousness. Radiological evaluation revealed massive intraventricular hemorrhage. After endoscopic hematoma removal, digital subtraction angiography (DSA) was performed to examine the vascular anatomy, which revealed numerous basal moyamoya vessels originating from the posterior cerebral artery. Three-dimensional rotational angiography identified a choroidal anastomosis originating from the posterior choroidal artery as the hemorrhage source. The patient had an RNF213 p.Arg4810Lys heterozygous variant in the germline. Based on the DSA findings, MMD was diagnosed, and the patient was transferred to a rehabilitation hospital with good postoperative consciousness. In conclusion, patients diagnosed with ICA occlusive disease may have late Suzuki stage MMD, potentially leading to major hemorrhage; therefore, antithrombotic medications should be administered with caution. In diagnosing ICA occlusive disease, the assessment of periventricular anastomosis should be considered, taking into account the possibility of MMD.

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Section: Discussionmentioning

confidence: 99%