Comparison of Operative and Conservative Treatment for Asymptomatic Moyamoya Disease: Preliminary Experience in Small Retrospective Series

Zeng, Hanhai; Guo, Yinghan; Yin, Li; Yu, Xiaobo; Yan, Feng; Tan, Xiaoxiao; Xu, Hangzhe; Peng, Yucong; Zhuang, Jianfeng; Zhou, Hang; Fu, Xiongjie; Wang, Lin; Gao, Chen

doi:10.1016/j.wneu.2020.11.045

Cited by 3 publications

(6 citation statements)

References 16 publications

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“…Surgical BR in MMD can prevent future cerebrovascular insults and avoid cognitive decline [116,117,227]. It is indicated in asymptomatic patients at the slightest sign of disease progression or patient neurological or mental impairment [103,234,235], particularly in the paediatric age group [62,103]. If performed early before irreversible damage, it can improve the neurological status and prevent the cognitive decline [103], stopping or at least slowing the progression of this nasty disease [136,206,234].…”

Section: Results Surgical Techniques Of Cerebral Revascularization In Moyamoya Diseasementioning

confidence: 99%

Surgical Treatment of Moyamoya Disease

Vanaclocha¹,

Saiz-Sapena²,

Vanaclocha³

2021

Moyamoya Disease - A Disease to Count on in Your Daily Practice

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Moyamoya disease is a rare cerebrovascular disease most prevalent in East Asian Countries. Thanks to the new diagnostic capabilities, the number of cases discovered has been rising steadily in the latest years, including many asymptomatic patients. But asymptomatic from the clinical point of view does not necessarily mean that there are no subjacent problems and that there will be no disease progression. Indeed, many patients harbour cognitive decline long before they start with clinical or even radiological manifestations. The only effective treatment is surgical revascularization, with all its possibilities: direct, indirect, and combined. While direct techniques are more useful in adult moyamoya patients, children seem to benefit most from indirect techniques. Additionally, indirect or combined procedures can be used as salvage procedures in case of unsatisfactory outcomes. Thus, many surgeons posit that surgical treatment should be considered in moyamoya patients, even if asymptomatic, particularly in the paediatric age group.

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Section: Results Surgical Techniques Of Cerebral Revascularization In Moyamoya Diseasementioning

confidence: 99%

Surgical Treatment of Moyamoya Disease

Vanaclocha¹,

Saiz-Sapena²,

Vanaclocha³

2021

Moyamoya Disease - A Disease to Count on in Your Daily Practice

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“…Moreover, these patients are not entirely asymptomatic but suffer from a steady cognitive decline in intelligence, spatial imagination, working memory, working memory-backwards digit span, computational ability, complex subtraction, complex arithmetic and word short-term memory [8,51], particularly in children [45,52,53]. This cognitive decay precedes the onset of clinical symptoms due to brain infarction, or haemorrhage [8] and inevitable worsens when these cerebrovascular insults happen [51,54]. Additionally, asymptomatic moyamoya patients can suffer from ischemic or haemorrhagic strokes [31].…”

Section: Asymptomatic Moyamoya Diseasementioning

confidence: 99%

“…Some have recommended performing surgical revascularization on asymptomatic moyamoya patients, particularly children, to prevent this unpleasant progressive neurological and cognitive deterioration [30,44,54]. Some have suggested undertaking surgical treatment if the ivy sign is seen in MRI flair imaging [47].…”

Section: Asymptomatic Moyamoya Diseasementioning

confidence: 99%

“…These antithrombotic agents are advised for the ischemic-type moyamoya disease [15]. In any case, they are not very useful [63] as some researchers have reported an almost 3-fold chance of future neurological deterioration in the patients treated conservatively compared to those treated surgically [54,64].…”

Section: Treatment Modalitiesmentioning

confidence: 99%

“…Direct, indirect or combined revascularization provides much better long-term results than conservative treatment, minimising the risk of ischemic and haemorrhagic strokes [54,65,66]. Early surgical intervention, particularly in paediatric patients, reduces cerebrovascular events and should be considered in asymptomatic children [44,67].…”

Section: Treatment Modalitiesmentioning

confidence: 99%

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Introductory Chapter: Moyamoya Disease, Silent Killer

Vanaclocha¹,

Saiz-Sapena²,

Vanaclocha³

2021

Moyamoya Disease - A Disease to Count on in Your Daily Practice

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The Recipient Vessel Hemodynamic Features Affect the Occurrence of Cerebral Edema in Moyamoya Disease After Surgical Revascularization: A Single-Center Retrospective Study

Tong

et al. 2022

Front. Neurol.

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ObjectiveIn moyamoya disease (MMD) with direct or combined revascularization, the initially hemodynamic recipient features are likely one of the main causes of acute hemodynamic disruption. Previous studies have explored the relationship between recipient diameter or flow velocity and postoperative complications, but there are still no optimal selection criteria with multiple potential recipient vessels. Cerebral edema is one of the most common radiological manifestations in the acute postoperative period. This study assessed the hemodynamic characteristics of cortex vessels related to postoperative cerebral edema.MethodsAll patients who had undergone direct or combined revascularization with preoperative digital subtraction angiography (DSA) between 2019 and 2021 were eligible for inclusion in this study. The application of DSA was performed and regular radiological examinations were employed after surgery. DSA was analyzed with the hemodynamic features within chosen recipient vessels. Cerebral edema was identified as a low-density image on CT or high signaling in the MRI T2 phase. The recipient hemodynamic characteristics and demographic presentation, as well as clinical data, were retrospectively analyzed in this study.ResultsA total of 103 patients underwent direct or combined revascularization with preoperative DSA. The mean age of this enrolled cohort was 44.31 ± 10.386 years, in which bilaterally involved MMD accounted for the main part. The preliminary correlation analysis found preoperative disease period (p = 0.078), recipients observed in angiography (p = 0.002), and surgery on the left (p = 0.097) may be associated with cerebral edema. The following regression analysis confirmed low occurrence of cerebral edema was accompanied by recipients observed in angiography (p = 0.003). After subdividing by flow direction and hemodynamic sources, the incidence rate of anterograde direction, anterior sources, and posterior sources were significantly lower than undetected recipients.ConclusionsCerebral edema is a common radiological manifestation in MMDs after surgery. In this study, the observation in angiography reliably identifies a variety of physiological or pathological recipient detection, flow direction, and hemodynamic sources in patients with MMD after revascularization, which indicates the selection strategy of potential recipients and highlights the importance of recipient observability in DSA. Meanwhile, vascular conditions determined by recipient hemodynamics meditate the occurrence of postoperative cerebral edema.

show abstract

Comparison of Operative and Conservative Treatment for Asymptomatic Moyamoya Disease: Preliminary Experience in Small Retrospective Series

Cited by 3 publications

References 16 publications

Surgical Treatment of Moyamoya Disease

Surgical Treatment of Moyamoya Disease

Introductory Chapter: Moyamoya Disease, Silent Killer

The Recipient Vessel Hemodynamic Features Affect the Occurrence of Cerebral Edema in Moyamoya Disease After Surgical Revascularization: A Single-Center Retrospective Study

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