Moyamoya disease, revascularisation surgery and anaesthetic considerations

Ilkhchoui, Yashar; Panikkath, Pramod V.; Martin, Hugo

doi:10.1136/bcr-2013-202784

Cited by 9 publications

(8 citation statements)

References 19 publications

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“…Similarly, a study noted that MMD has a bimodal age distribution with one peak in the first decade of life and the other in the fourth decade of life. [ 5 ] A previous study indicated that patient age was a significant factor to predict postoperative symptomatic hyperperfusion in patients with MMD. [ 8 ] In contrast to the previous report, this study showed that patient age was not associated with postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 – 4 ] The clinical presentation of MMD mainly includes ischemic stroke, transient ischemic attack, headache, and seizure. [ 5 , 6 ] No medicines, such as antiaggregants, antiepileptics, or vasodilators, are proven to cure or reverse the progression of MMD. [ 6 ] Medicines for MMD only aim to reduce the impact of the symptoms and the risk of thrombosis and sustain normotension.…”

Section: Introductionmentioning

confidence: 99%

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Effects of end-tidal carbon dioxide levels in patients undergoing direct revascularization for Moyamoya disease and risk factors associated with postoperative complications

et al. 2021

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A history of transient ischemic attack, severity of disease, urinary output, hematocrit, hypocapnia, and hypotension during direct revascularization (superficial temporal artery to middle cerebral artery [STA-MCA]) in patients with Moyamoya disease (MMD) may lead to a poor prognosis, however, to our knowledge evidence for end-tidal carbon dioxide (ETCO2) targets is lacking. Within the ranges of standardized treatment, the article was primarily designed to study the risk factors associated with the neurologic outcomes during STA-MCA for MMD especially including ETCO2 ranges and the duration in different groups. The primary goals of this study were to investigate the risk factors for neurologic deterioration and explore the association between ETCO2 ranges and neurologic outcome during general anesthesia for STA-MCA. This retrospective observational study included 56 consecutively adult Moyamoya patients who underwent STA-MCA under general anesthesia between January 2015 and August 2019. ETCO2 was summarized per patient every 5 minutes. Clinical outcome was assessed with clinical presentation, computed tomography findings, magnetic resonance imaging findings, cerebral angiography, and the modified Rankin Scale scores at discharge as main outcome measure. The outcomes were also compared for the duration of surgery, anesthesia, and the length of stay. A total of 56 patients were studied, all patients had comprehensive ETCO2 measurements. The incidence of postoperative complications was 44.6% (25/56). There was no association between age, sex, hypertension, diabetes, smoking history, drinking history, sevoflurane use, invasive arterial blood pressure monitoring, combined encephalomyosynangiosis and postoperative complications. Duration of surgery (P = .04), anesthesia (P = .036), hospital stay (P = .023) were significant correlates of postoperative complications. In the multiple logistic regression model, they were not the significant predictors. The ETCO2 ranges and the length of time in different groups within the current clinical setting was not associated with postoperative complications (P > .05). Within a standardized intraoperative treatment strategy, we found that postoperative complications had no significant correlation with sex, age, hypertension, diabetes, smoking history, drinking history, invasive arterial blood pressure monitoring, combined encephalomyosynangiosis, or sevoflurane use. Further, hypocapnia and hypercapnia during STA-MCA were not found to be associated with postoperative complications in patients with MMD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of end-tidal carbon dioxide levels in patients undergoing direct revascularization for Moyamoya disease and risk factors associated with postoperative complications

et al. 2021

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“…It is either direct, in which the superficial temporal artery branch of the external carotid artery is directly anastomosed with the middle cerebral artery, or indirect as in synangiosis procedures, where muscle or dura are placed in contact with the surface of the ischaemic brain. Indications for revascularization surgery include ischaemic symptoms or underperfused hemispheres [50]. Secondary stroke prevention using antiplatelets is recommended.…”

Section: Moyamoya Angiopathymentioning

confidence: 99%

Livedo racemosa in neurological diseases: an update on the differential diagnoses

Mitri

Enk

Bersano

et al. 2020

Euro J of Neurology

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Livedo is a net‐like violaceous skin pattern. It can be classified as physiological or pathological. The physiological livedo reticularis usually appears in cold conditions, whereas the pathological and irregular livedo, which persists in warm temperatures, is often labeled as ‘livedo racemosa’. Some neurological pathologies are associated with livedo, most commonly those with an inflammatory component or those derived from systemic disorders. The present review summarizes the most important central and peripheral neurological diseases in pediatric and adult age groups associated with livedo, providing physicians with an overview of the clinical presentation, etiology, diagnosis and management of these conditions.

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“…17,18 The use of propofol may suppress cerebral metabolism and cause a decrease in cerebral blood flow. 19,20 The cerebral effects of opioids that may result in a modest reduction in the cerebral metabolic rate and intracranial pressure depend on systemic hemodynamics, concomitant use of other anesthetic agents, and underlying comorbidities. However, opioids are potent analgesics and are beneficial in stabilizing patient hemodynamics.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Anesthesiology Management and Patient Outcomes for Surgical Revascularization for Moyamoya Disease: A Review and Clinical Experience

Williams¹,

Jones²,

Chaudhry

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Background Moyamoya disease (MMD) is a rare cerebrovascular condition, often presenting as a headache or stroke in adults. Anesthetic management of this illness may challenge providers because it can affect the long-term neurologic outcome and hospital length of stay (LOS) in patients with MMD. Materials and Methods A literature search was conducted to assess etiology and epidemiology, as well as existing reports of intraoperative management of MMD. Due to sparse findings, the search was expanded to include studies of the use of intraoperative anesthetic agents during other neurosurgical procedures. We also retrospectively reviewed all MMD cases from January 1, 2009, to December 31, 2015, at Memorial Hermann Hospital-Texas Medical Center, where intraoperative management involved craniotomy and surgical revascularization. Data were collected primarily on the use of several anesthetic agents. The LOS and any adverse events were also recorded for each case. The data were divided into two equivalent case cohorts: (1) January 1, 2009, to February 18, 2013, and (2) February 19, 2013, to December 31, 2015. Results Remifentanil use notably increased between the first and second time periods while fentanyl use decreased. Desflurane usage also demonstrated an observed increase when our two cohorts were compared. Additionally, there was a decrease in the mean LOS between the first and second periods of 3.9 and 3.3 days, respectively. Conclusion Increasing use of remifentanil in MMD cases could be attributed to its ability to provide more stable hemodynamics during induction, maintenance, and emergence of anesthesia when compared with fentanyl. Lower systolic pressures, diastolic pressures, and heart rates were reported in patients receiving remifentanil over fentanyl.

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Moyamoya disease, revascularisation surgery and anaesthetic considerations

Abstract: We report a case of a rare disease that requires a unique anaesthetic approach for a unique surgical procedure. Anaesthesiologists need to be familiar with different pathophysiological aspects of this disease and its perioperative management.

Cited by 9 publications

References 19 publications

Effects of end-tidal carbon dioxide levels in patients undergoing direct revascularization for Moyamoya disease and risk factors associated with postoperative complications

Effects of end-tidal carbon dioxide levels in patients undergoing direct revascularization for Moyamoya disease and risk factors associated with postoperative complications

Livedo racemosa in neurological diseases: an update on the differential diagnoses

Intraoperative Anesthesiology Management and Patient Outcomes for Surgical Revascularization for Moyamoya Disease: A Review and Clinical Experience

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