Histopathological studies on spontaneous occlusion of the circle of Willis (cerebrovascular Moyamoya disease)

Hosoda, Yasuhiro; Ikeda, Eiji; Hirose, Shigemichi

doi:10.1016/s0303-8467(97)00044-9

Cited by 79 publications

(45 citation statements)

References 14 publications

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“…21,38 Because the development of collateral vessels (moyamoya vessels) is generally not remarkable in adults, abrupt occlusion may cause more severe consequences in adults than in pediatric patients. 17 Furthermore, hyperperfusion is more frequent in adults than in pediatric patients. 60 Therefore, an immediate increase in cerebral blood flow may have a more detrimental effect on the operated hemisphere in adults than in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review

Kazumata

Ito

Tokairin

et al. 2014

JNS

162

111

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M oyaMoya disease (MMD) is a progressive stenoocclusive cerebrovascular disease characterized by collateral vascular networks that look like "a puff of smoke" (moyamoya vessels) at the base of the brain. 35,58 Various revascularization procedures have been shown to improve cerebral hemodynamics and decrease the risk of ischemic attack; however, hemodynamic compromises and bleeding-prone vasculopathy lead to postoperative neurological morbidity. In anesthesia management, hypocapnia during surgery induces critical decreases in cerebral blood flow. It is also well known that crying induces hyperventilation and stroke during the perioperative period in children. 45,51 Hemodynamic compromise is also aggravated by blood loss, decreased circulating volume, and low blood pressure. 38,53 Furthermore, recent studies have shown that postoperative hyperperfusion develops frequently after surgery. 11,60 A previous review suggested that direct and combined bypass for MMD provide better collateral circula- Object. Although combined direct and indirect anastomosis in patients with moyamoya disease immediately increases cerebral blood flow, the surgical procedure is more complex. Data pertinent to the postoperative complications associated with combined bypass are relatively scarce compared with those associated with indirect bypass. This study investigated the incidence and characteristics of postoperative stroke in combined bypass and compared them with those determined from a literature review to obtain data from a large population.Methods. A total of 358 revascularization procedures in 236 patients were retrospectively assessed by reviewing clinical charts and radiological data. PubMed was searched for published studies on surgical treatment to determine the incidence of postoperative complications in a larger population.Results. Seventeen instances of postoperative stroke were observed in 16 patients (4.7% per surgery, 95% CI 2.8%-7.5%). Postoperative stroke was more frequent (7.9% per surgery) in adults than in pediatric patients (1.7% per surgery, OR 4.07, 95% CI 1.12-14.7; p < 0.05). Acute progression of stenoocclusive changes were identified in the major cerebral arteries (anterior cerebral artery, n = 3; middle cerebral artery, n = 1; posterior cerebral artery, n = 2). The postoperative stroke rate was comparable with that (5.4%) determined from a literature search that included studies reporting more than 2000 direct/combined procedures. No differences in the stroke rates between the direct/combined and indirect procedures were found. In the literature review, direct/combined bypass was more often associated with excellent revascularization (angiographic opacification greater than two-thirds) than indirect bypass (p < 0.05).Conclusions. This experience of 358 consecutive procedures is one of the largest series for which the postoperative stoke rate for direct/combined bypass performed with a unified strategy has been reported. A systematic review confirmed that the postoperative stroke rate for the direct/combined pro...

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Section: Discussionmentioning

confidence: 99%

The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review

Kazumata

Ito

Tokairin

et al. 2014

JNS

162

111

View full text Add to dashboard Cite

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“…On the other hand, a hypothesis of abnormal thrombogenesis has been advanced by Hosoda et al, 17) who reported that thromboemboli are occasionally (around 50% in their autopsy cases) seen in the internal wall of the moyamoya artery and its distribution correlates well with the character of moyamoya disease. They have suggested that abnormal thrombogenesis plays an important role in the etiology of this disease.…”

Section: Pathological Study and Abnormal Thrombogenesismentioning

confidence: 99%

Review of Past Research and Current Concepts on the Etiology of Moyamoya Disease

Houkin

Ito

Sugiyama

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Research on moyamoya disease has progressed remarkably in the past several decades. Indeed, many new facts concerning the epidemiology of the disease have been revealed and surgical treatments have been drastically improved. However, despite extensive research, the mechanism of moyamoya disease is still unknown. Consequently, the cardinal treatment of this disease has not yet been developed. For further clarification of its etiology, innovative studies are therefore indispensable. The aim of this paper is to review research on the pathogenesis of moyamoya disease to identify milestones in the direction of its true solution. Many hypotheses of the pathogenesis of moyamoya disease have been proposed in the past half century, including infection (viral and bacterial), autoimmune disorders, proteins abnormality, and gene abnormality. Some of these are now considered to be historical achievements. Others, however, can be still subjected to contemporary research. Currently, several genetic abnormalities are considered to offer the most probable hypothesis. In addition, interesting papers have been presented on the role of the endothelial progenitor cell on the pathogenesis of moyamoya disease. Intuitively, however, it appears that a single theory cannot always explain the pathogenesis of this disease adequately. In other words, the complex mechanism of several factors may comprehensively explain the formation of moyamoya disease. The``double hit hypothesis'' is probably the best explanation for the complicated pathology and epidemiology of this disease.

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“…12) Histological investigations of autopsy specimens have demonstrated that the main vascular lesion in MMD is stenosis or occlusion caused by fibrocellular intimal thickening. 6,8,15,19) Patients with MMD are usually treated by superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery or indirect revascularization. 7,9) During this surgery, the MCA is often observed to have a thin wall and to appear transparent.…”

Section: Introductionmentioning

confidence: 99%

“…16) Several studies on extracranial vessels have been reported, [1][2][3][4][5]11) but few on the intracranial arteries from patients with MMD except those based on autopsy specimens. 6,8,15,19) The present study histologically analyzed a series of samples of MCA walls obtained from patients treated for MMD to explore the characteristics of the intracranial arterial walls in MMD.…”

Section: Introductionmentioning

confidence: 99%

Histological Features of Middle Cerebral Arteries From Patients Treated for Moyamoya Disease

Takagi

Kikuta

Nozaki

et al. 2007

Neurol. Med. Chir.(Tokyo)

143

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Moyamoya disease (MMD) is a cerebrovascular occlusive disease characterized by progressive stenosis or occlusion at the distal ends of the bilateral internal carotid arteries. Vascular structural changes were previously detected using postmortem specimens. This study investigated 35 specimens of the middle cerebral artery (MCA) from 25 patients undergoing surgical treatment for MMD. Six MCA samples were also obtained from six control subjects. Histological examination showed that MCA specimens from patients with MMD had significantly thinner media and thicker intima than control specimens. In addition, abnormal findings of the internal elastic lamina and eosin-positive deposits in the intima were detected. Medial thinness and intimal hyperplasia occurred in the MCA of patients with MMD.

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Histopathological studies on spontaneous occlusion of the circle of Willis (cerebrovascular Moyamoya disease)

Cited by 79 publications

References 14 publications

The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review

The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review

Review of Past Research and Current Concepts on the Etiology of Moyamoya Disease

Histological Features of Middle Cerebral Arteries From Patients Treated for Moyamoya Disease

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