Changes in cerebral hemodynamics following encephalo-duro-arterio-synangiosis (EDAS) in young patients with moyamoya disease

Suzuki, Ryuta; Matsushima, Yoshiharu; Takada, Yoshiaki; Nariai, Tadashi; Wakabayashi, Shigeo; Tone, Osamu

doi:10.1016/0090-3019(89)90065-7

Cited by 54 publications

(14 citation statements)

References 12 publications

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“…Sequential changes after revascularization surgery in moyamoya disease patients have been documented by conventional angiography and magnetic resonance angiography (MRA) [6, 14, 15]. These include a decrease in moyamoya vessels, the development of superficial and deep temporal artery collaterals, and progression of ICA steno-occlusive changes [14, 15].…”

Section: Discussionmentioning

confidence: 99%

“…These include a decrease in moyamoya vessels, the development of superficial and deep temporal artery collaterals, and progression of ICA steno-occlusive changes [14, 15]. The progression of ICA stenosis is often of no clinical significance since most of these patients improve neurologically as cerebral hemodynamics improve following successful revascularization.…”

Section: Discussionmentioning

confidence: 99%

“…While anterior circulation changes and the dynamic process of neovascularization in patients receiving revascularization are well documented in the literature, there are no studies focusing on posterior circulation changes in these patients [6, 14, 15]. Therefore, we studied the relationship between changes in the posterior and anterior circulations and cerebral hemodynamics in 23 patients with moyamoya disease who underwent revascularization.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Significance of Posterior Circulation Changes after Revascularization in Patients with Moyamoya Disease

Huang¹,

Liu

Lai³

et al. 2009

Cerebrovasc Dis

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Objective: It has been noted that the posterior circulation serves as an important source of collateral blood supply in moyamoya disease. Since most of the literature has focused on non-operative cases and many symptomatic patients receive surgical revascularization, we evaluated the posterior circulation changes after revascularization and found that progressive posterior cerebral artery (PCA) steno-occlusive changes after revascularization caused cerebral hemodynamic compromise and clinical deterioration in a significant portion of patients. Methods: Twenty-three moyamoya disease patients with ischemic presentation who received revascularization with complete angiography and xenon CT during a minimum of 3 years’ clinical follow-up were enrolled. Revascularization was performed in 38 hemispheres. Pre- and postoperative angiography were reviewed to determine the internal carotid artery (ICA) stage, PCA stage, leptomeningeal collateral (LMC) grade, and Matsushima synangiosis grade. The postoperative regional cerebral blood flow (CBF) and cerebral vascular reserve (CVR) were recorded and correlated with angiographic findings and clinical outcome. Results: Progression of ICA staging was noted in 23 sides (55.2%), and progression of PCA staging was noted in 18 sides (47.4%). Among the 18 cases of PCA stage progression, an associated decrease in LMC grade was noted in 12 sides (66.7%). These changes were associated with decreased regional CBF and CVR, which also explained the recurrent ischemic symptoms in 27.8% of these patients. In contrast, LMC grade increased in 15 (65.2%) sides of patients with ICA progression. Conclusions: Progressive steno-occlusive change in the PCA after revascularization is associated with a reduction in LMC blood flow and cerebral ischemia in moyamoya patients. This phenomenon might cause recurrent ischemic symptoms in 27.8% of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Significance of Posterior Circulation Changes after Revascularization in Patients with Moyamoya Disease

Huang¹,

Liu

Lai³

et al. 2009

Cerebrovasc Dis

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“…We also have detailed clinical records on IQs and morphological and functional neuroimaging for analysis. 3,12,13,17,[19][20][21]26 This type of single-institute study should be useful in considering the genetic characteristics of MMD and in finding clues on the pathognomonic features of this syndrome.…”

Section: ©Aans 2013mentioning

confidence: 99%

Clinical features of familial juvenile cases of moyamoya disease: analysis of patients treated in a single institute over a 28-year period

Mukawa

Nariai²,

Ohno³

2013

PED

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Object The authors compared the clinical features between familial and sporadic cases of moyamoya disease (MMD) by retrospectively analyzing data on patients with MMD registered in the database of Tokyo Medical and Dental University over a period of 28 years. Methods In total, 383 patients with hospital records at Tokyo Medical and Dental University from 1980 to 2007 were registered into the database. The data on all of these patients were retrospectively reviewed to clarify the occurrence of familial cases. Clinical features of child or adolescent patients (< 20 years of age) with MMD were compared between familial and sporadic cases in a subgroup of patients who were registered after 1995, initially diagnosed using MR angiography, and assessed using an intelligence scale. Results Familial occurrence was observed in 59 patients (15.4%) in 40 pedigrees. The clinical features of juvenile patients were analyzed in 124 patients, 22 (17.7%) of whom had familial histories. In comparison with the sporadic cases, patients with familial histories were significantly younger at onset (4.7 vs 6.6 years old), had significantly more cortical infarction (59.1% vs 25.5%), and had significantly more stenoocclusive lesions in the posterior cerebral artery (45.4% vs 24.5%). The rate of patients with intellectual disturbance (intelligence quotient < 75) was significantly larger in the familial cases (47.4%) than in the sporadic cases (17.8%). Conclusions This survey of the clinical features of familial MMD suggests that patients with familial MMD had a more serious clinical course in childhood than the sporadic MMD cases.

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“…The process of angiogenesis may take several weeks or months before revascularization from the deep temporal artery is sufficient. 40 Takeuchi et al 43 treated 10 pediatric patients with signs of cerebral ischemia without intracranial hemorrhage with temporal muscle grafts. Transient ischemic attacks were halted completely in 4 of 7 patients and decreased significantly in the remaining 3.…”

Section: Encephalomyosynangiosismentioning

confidence: 99%

Surgical management of moyamoya disease

Baaj

Agazzi

Sayed

et al. 2009

FOC

175

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Moyamoya disease (MMD) is a progressive, occlusive disease of the distal internal carotid arteries associated with secondary stenosis of the circle of Willis. Symptoms include ischemic infarcts in children and hemorrhages in adults. Bypass of the stenotic vessel(s) is the primary surgical treatment modality for MMD. Superficial temporal artery-to-middle cerebral artery bypass is the most common direct bypass method. Indirect techniques rely on the approximation of vascularized tissue to the cerebral cortex to promote neoangiogenesis. This tissue may be in the form of muscle, pericranium, dura, or even omentum. This review highlights the surgical options available for the treatment of MMD.

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Changes in cerebral hemodynamics following encephalo-duro-arterio-synangiosis (EDAS) in young patients with moyamoya disease

Cited by 54 publications

References 12 publications

Clinical Significance of Posterior Circulation Changes after Revascularization in Patients with Moyamoya Disease

Clinical Significance of Posterior Circulation Changes after Revascularization in Patients with Moyamoya Disease

Clinical features of familial juvenile cases of moyamoya disease: analysis of patients treated in a single institute over a 28-year period

Surgical management of moyamoya disease

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