Reconstructive Operation for Moyamoya Disease

Nakagawa, Yoku; Gotoh, Satoshi; Shimoyama, Mitsuo; Ohtsuka, K; Mabuchi, Shoji; Sawamura, Yutaka; Abe, Hiroshi; Tsuru, Mitsuo

doi:10.2176/nmc.23.464

Cited by 30 publications

(6 citation statements)

References 4 publications

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“…While the effectiveness of revascularization for ischemic MMD has been generally accepted, surgical indications for MMD with a hemorrhagic presentation also remain undetermined. In the 1980s, indirect revascularization was considered to be more effective for prevention of further hemorrhage than direct revascularization [ 72 ]. However, Aoki reported unsatisfactory results for prevention of recurrent hemorrhage using indirect revascularization [ 73 ].…”

Section: Treatment Outcomesmentioning

confidence: 99%

Moyamoya Disease: Treatment and Outcomes

et al. 2016

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Although the pathogenesis of moyamoya disease (MMD) has not been fully elucidated, the effectiveness of surgical revascularization in preventing stroke has been addressed by many studies. The main mechanism of surgical revascularization is augmenting the intracranial blood flow using an external carotid system by either direct bypass or pial synangiosis. This can improve resting cerebral blood flow as well as vascular reserve capacity. For direct revascularization, the superficial temporal artery is used as the donor artery in most cases, although the occipital artery may be used in limited cases. Usually, the cortical branch of the middle cerebral artery is selected as the recipient of direct anastomosis. As for indirect revascularization, various techniques using different kinds of connective tissues have been introduced. In some cases, reinforcing the anterior cerebral artery and the posterior cerebral artery territories can be considered. The effectiveness of surgical revascularization for preventing ischemic stroke had been generally accepted by many studies. However, for preventing hemorrhagic stroke, new evidence has been added by a recent randomized controlled trial. The incidence of peri-operative complications such as stroke and hyperperfusion syndrome seems to be high due to the nature of the disease and technical demands for treatment. Preventing and adequately managing these complications are essential for ensuring the benefits of surgery.

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Section: Treatment Outcomesmentioning

confidence: 99%

Moyamoya Disease: Treatment and Outcomes

et al. 2016

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“…Subdural hygroma caused by tearing of the arachnoid membrane has a potential risk for compression of the brain like swollen temporal muscle in EMS reported by Fujimura et al3) In addition, theoretically, the mass effect can cause mechanical tearing of the suture site between donor and recipient artery due to tension caused by thickness of collected fluid. Favorable outcomes were reported for postoperative CSDH, except for one death 6). Therefore, discussion about prevention of postoperative subdural fluid collection is very important and worthwhile.…”

Section: Discussionmentioning

confidence: 99%

“…Favorable outcomes were reported for postoperative CSDH, except for one death. 6) Therefore, discussion about prevention of postoperative subdural fluid collection is very important and worthwhile.…”

Section: Discussionmentioning

confidence: 99%

Arachnoid Membrane Suturing for Prevention of Subdural Fluid Collection in Extracranial-intracranial Bypass Surgery

Kim

Joo

Kim

et al. 2014

J Cerebrovasc Endovasc Neurosurg

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ObjectiveWater-tight closure of the dura in extracranial-intracranial (EC-IC) bypass is impossible because the superficial temporal artery (STA) must run through the dural defect. Consequently, subdural hygroma and subcutaneous cerebrospinal fluid (CSF) collection frequently occur postoperatively. To reduce these complications, we prospectively performed suturing of the arachnoid membrane after STA-middle cerebral artery (STA-MCA) and evaluated the clinical usefulness.Materials and MethodsBetween Mar. 2005 and Oct. 2010, extracranial-intracranial arterial bypass (EIAB) with/without encephalo-myo-synangiosis was performed in 88 cases (male : female = 53 : 35). As a control group, 51 patients (57 sides) underwent conventional bypass surgery without closure of the arachnoid membrane. Postoperative computed tomography (CT) scan was performed twice in three days and seven days later, respectively, for evaluation of the presence of subdural fluid collection and other mass lesions.ResultsThe surgical result was excellent, with no newly developing ischemic event until recent follow-up. The additional time needed for arachnoid suture was five to ten minutes, when three to eight sutures were required. Post-operative subdural fluid collection was not seen on follow-up computed tomography scans in all patients.ConclusionArachnoid suturing is simple, safe, and effective for prevention of subdural fluid collection in EC-IC bypass surgery, especially the vulnerable ischemic hemisphere.

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“…In addition, the temporary occlusion of the MCA branch that is required during the anastomosis can interrupt the leptomeningeal collateral branches seen in these patients and result in a stroke. 15,22 Attention has therefore turned mainly to indirect methods of revascularization.…”

Section: Discussionmentioning

confidence: 99%

Dural inversion procedure for moyamoya disease

Dauser¹,

Tuite²,

McCluggage³

1997

Journal of Neurosurgery

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A variety of surgical procedures have been proposed for the treatment of moyamoya disease, but few have used the potential of the middle meningeal artery to any great extent. During the period of spontaneous collateral formation, patients with this disease are at risk for the development of transient ischemic attacks and strokes. Surgical treatments aimed at increasing collateral flow to the brain from the external carotid system have included both direct and indirect anastomotic methods. In this report, the authors describe a technique that used the middle meningeal artery circulation as a source of collateral blood supply by inverting dural flaps that are located on a large meningeal vessel, allowing the richly vascularized outer dural surface to contact a large surface area of the ischemic cortex. An extensive degree of revascularization was observed.

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Reconstructive Operation for Moyamoya Disease

Cited by 30 publications

References 4 publications

Moyamoya Disease: Treatment and Outcomes

Moyamoya Disease: Treatment and Outcomes

Arachnoid Membrane Suturing for Prevention of Subdural Fluid Collection in Extracranial-intracranial Bypass Surgery

Dural inversion procedure for moyamoya disease

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