Long-term outcome after STA-MCA anastomosis for moyamoya disease

Miyamoto, Susumu; Akiyama, Yoshinori; Nagata, Izumi; Karasawa, Jun; Nozaki, Kazuhiko; Hashimoto, Nobuo; Kikuchi, Hiroe

doi:10.3171/foc.1998.5.5.8

Cited by 94 publications

(41 citation statements)

References 10 publications

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“…Superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and indirect synangiosis are known to improve cerebral hemodynamics and are used to reduce the risk of subsequent cerebrovascular events and contribute to improve long-term outcome in patients with moyamoya disease, although the value of this approach has only been shown by clinical trial in adults to prevent intracerebral hemorrhage. [3][4][5][6][7][8][9][10] Using single photon emission computed tomography and positron emission tomography (PET), many previous studies have shown that surgical revascularization improves the parameters of cerebral hemodynamics, including cerebral blood flow (CBF), cerebral blood volume (CBV), cerebrovascular reactivity to acetazolamide, and elevated oxygen extraction fraction (OEF) in moyamoya disease. These beneficial effects are prominent especially in the frontal lobe.…”

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confidence: 99%

Effects of Surgical Revascularization on Cerebral Oxygen Metabolism in Patients With Moyamoya Disease

Kuroda

Kashiwazaki

Hirata

et al. 2014

Stroke

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O-gas positron emission tomography were performed before and 3 to 4 months after surgery. Hemodynamic and metabolic parameters were precisely quantified and statistically analyzed. Results-Preoperative positron emission tomographic scans revealed that cerebral blood flow was decreased, cerebral blood volume was increased, and cerebral metabolic rate for oxygen was decreased in both pediatric and adult patients. Cerebral metabolic rate for oxygen reduction was observed in ≈80% of pediatric (16/21; 76%) and adult hemispheres (38/48; 79%). Surgical revascularization resolved hemodynamic compromise in all operated hemispheres. Cerebral metabolic rate for oxygen significantly improved in pediatric patients without parenchymal lesions (n=8), but not those with parenchymal lesions (n=8). Multivariate analysis revealed that cerebral metabolic rate for oxygen significantly improved in younger adult patients without parenchymal lesions (P=0.0264; odds ratio, 0.88; 95% confidence interval, 0.79-0.99). Conclusions-Cerebral oxygen metabolism is significantly depressed in ≈80% of the involved hemispheres of moyamoya disease and improves in pediatric and younger adult patients without parenchymal lesions after bypass surgery. Cerebral oxygen metabolism may be reversibly depressed in response to cerebral ischemia in them although the underlying mechanisms are still unclear. (Stroke. 2014;45:2717-2721.)Key Words: brain ischemia ◼ bypass surgery ◼ moyamoya disease ◼ positron emission tomography

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confidence: 99%

Effects of Surgical Revascularization on Cerebral Oxygen Metabolism in Patients With Moyamoya Disease

Kuroda

Kashiwazaki

Hirata

et al. 2014

Stroke

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“…4,14) Accordingly, intracranial ischemic and hemorrhagic attacks are believed to increase in pregnancy. 5,17) In MMD, an EC-IC bypass has been reported to apparently improve hemodynamic ischemia, 10,11) so it is possible that previous surgical treatments serve to protect against perinatal ischemic stroke to some extent. However, neither positive nor negative effect of EC-IC bypass on the pregnancy and delivery with MMD was proved in this survey.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy and Delivery in Moyamoya Disease: Results of a Nationwide Survey in Japan

Takahashi

Ikeda

Iihara

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Stroke during pregnancy associated with moyamoya disease (MMD) has been reported sporadically, but no systematic surveys have been undertaken. To reveal the current clinical situation, the authors conducted Japan's first nationwide survey of pregnancy and delivery associated with MMD. A questionnaire was sent to all 270 perinatal medical centers across Japan to survey their experiences with delivery associated with MMD within the preceding 5 years (Survey I); another questionnaire was sent to 554 adult female patients with MMD regarding their experience with childbirth (Survey II). Survey I included 59 deliveries among patients with previously diagnosed MMD. The incidence of perinatal neurological events and morbidity was 5.1% and 1.7%, respectively. In another five cases, newly diagnosed after perinatal attacks, disability was noted in three cases, including one death from intracranial hemorrhage. Survey II included 278 deliveries. The perinatal attack rate was 6.6% in 76 previously diagnosed cases and 2.0% in 202 cases undiagnosed at pregnancy, but neither group reported permanent morbidity. Caesarean section in previously diagnosed cases accounted for 76.3% of deliveries in Survey I and 69.7% in Survey II, but no significant difference in event rate was found between caesarean section and vaginal delivery in either survey. Although the incidence of perinatal neurological events is low when MMD has been diagnosed, careful monitoring is required in light of the potential for stroke. Serious events, especially intracranial hemorrhage, can occur if MMD has not been diagnosed at pregnancy. Further efforts to establish management guidelines are required to ensure safer childbirth in patients with MMD.

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“…Several comparison studies between the direct and the indirect techniques have been performed. In patients with reduced CBF, the direct procedure is often more effective for a more rapid increase in blood flow to the affected brain region [91,[93][94][95][96][97][98].…”

Section: Direct Revascularizationmentioning

confidence: 99%