Epidural Anesthesia for a Patient with Moyamoya Disease Presenting for Cesarean Section

Ten-year experience of 44 patients with moyamoya disease from a single institution

“…4,5,14,15 There are sporadic case reports and studies reporting this disease from countries other than in eastern Asia. [15][16][17][18][19][20][21][22][23][24][25][26][27] The peak incidence is in children where it manifests as ischemia however a second smaller peak occurs in the fourth decade and tends to manifest as hemorrhage. 28 The isolated sporadic variety of the disease predominates, but a familial version has been identified.…”

Anesthetic management for cesarean section in moyamoya disease: a report of five consecutive cases and a mini-review

“…1 Indeed, neurological deterioration has been reported during pregnancy and puerperium in patients known to have moyamoya disease. 4,10,11 The principle of anesthetic management for patients with moyamoya disease is to maintain normotension and normocapnia. 4,10 Hypertension can cause intracranial hemorrhage.…”

“…10, 19 Sharma et al opted for neuraxial anesthesia because of the aforementioned advantages specific to moyamoya disease, and because of its clear benefits for mothers and babies in general. 10 They also expected that hypotension could be easily treated by ephedrine, intravenous fluid and uterine displacement. Hypotension was not noted in their case.…”

“…CSE anesthesia combines the speed, density, and reliability of a spinal with the flexibility of an epidural. Six cases of epidural [9][10][11]15,19,21 and three cases of CSE 13,20,22 anesthesia have been reported. Ngan Kee suggested that epidural anesthesia should be the technique of choice for cesarean section in moyamoya disease because hemodynamic fluctuations could be minimized.…”

Approach to A Pregnant Woman with Moyamoya Syndrome

“…Both general and neuraxial anesthesia have been used successfully. Moyamoya disease has been known for 40 years and is most common in East Asia, especially in Japan [4,9]. The number of sufferers in Japan was approximately 6000 in 1996 (4.7 per 100 000 population).…”