J Cerebrovasc Endovasc Neurosurg.  2012 Sep;14(3):216-222. 10.7461/jcen.2012.14.3.216.

Angiographic Results of Indirect and Combined Bypass Surgery for Adult Moyamoya Disease

Affiliations
  • 1Department of Neurosurgery, Soonchunhyang University Hospital, Seoul, Korea. chosj@schmc.ac.kr

Abstract


OBJECTIVE
The aim of this study was to compare the efficacy of indirect and combined bypass surgery for treatment of adult moyamoya disease (MMD). The definition of combined bypass surgery is a combination of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and indirect anastomosis. Development of collateral circulation after surgery was investigated.
METHODS
Forty three patients (58 hemispheres) with MMD were followed by cerebral angiography for at least six months after surgery, between May 2002 and July 2011. Indirect and combined revascularization surgeries were performed in 33 and 25 cases, respectively. Good outcome was defined as more than group B, in accordance with the method suggested by Matsushima.
RESULTS
Development of collateral circulation was not affected by sex (p = 0.493), clinical features (p = 0.206), or Suzuki stage (p = 0.428). Based on postoperative cerebral angiography, the combined bypass surgery group showed a better angiographic outcome, than the encephaloduroarteriomyosynangiosis (EDAMS) group (p = 0.100, odds ratio [OR] 4.107, 95% confidence interval [CI] 0.700 - 24.096). The combined bypass group showed a better response than the encephaloduroarteriogaleosynangiosis (EDAGS) group (p = 0.088, OR 4.600, 95% CI 0.721 - 29.332). Similar responses were observed for EDAGS and EDAMS (p = 0.886, OR 1.120, 95% CI 0.239 - 5.251). The combined bypass group showed a better response than the indirect group (p = 0.064, OR 4.313, 95% CI 0.840 - 22.130).
CONCLUSION
Results of this study demonstrate that combined bypass results in better revascularization on angiographic evaluation in adult MMD. Therefore, among surgical procedures, combined bypass is a choice that can be recommended.

Keyword

Moyamoya disease; Cerebral revascularization; Indirect bypass surgery; Combined bypass surgery

MeSH Terms

Adult
Cerebral Angiography
Cerebral Arteries
Cerebral Revascularization
Collateral Circulation
Humans
Moyamoya Disease
Odds Ratio

Cited by  1 articles

A Recent Update of Clinical and Research Topics Concerning Adult Moyamoya Disease
Jin Pyeong Jeon, Jeong Eun Kim
J Korean Neurosurg Soc. 2016;59(6):537-543.    doi: 10.3340/jkns.2016.59.6.537.


Reference

1. Amine AR, Moody RA, Meeks W. Bilateral temporal-middle cerebral artery anastomosis for Moyamoya syndrome. Surg Neurol. 1977. 07. 8(1):3–6.
2. Czabanka M, Vajkoczy P, Schmiedek P, Horn P. Age-dependent revascularization patterns in the treatment of moyamoya disease in a European patient population. Neurosurg Focus. 2009. 04. 26(4):E9.
Article
3. Dauser RC, Tuite GF, McCluggage CW. Dural inversion procedure for moyamoya disease. Technical note. J Neurosurg. 1997. 04. 86(4):719–723.
4. Erickson DL, Koivukangas J. The treatment of Moyamoya disease by superficial temporal-middle cerebral artery (STA-MCA) anastomosis. Ann Clin Res. 1986. 18:Suppl 47. 21–24.
5. Goda M, Isono M, Ishii K, Kamida T, Abe T, Kobayashi H. Long-term effects of indirect bypass surgery on collateral vessel formation in pediatric moyamoya disease. J Neurosurg. 2004. 02. 100:2 Suppl Pediatrics. 156–162.
Article
6. Golby AJ, Marks MP, Thompson RC, Steinberg GK. Direct and combined revascularization in pediatric moyamoya disease. Neurosurgery. 1999. 07. 45(1):50–58. discussion 58-60.
Article
7. Han DH, Nam DH, Oh CW. Moyamoya disease in adults: characteristics of clinical presentation and outcome after encephalo-duro-arterio-synangiosis. Clin Neurol Neurosurg. 1997. 10. 99:Suppl 2. S151–S155.
8. Houkin K, Kamiyama H, Takahashi A, Kuroda S, Abe H. Combined revascularization surgery for childhood moyamoya disease: STA-MCA and encephalo-duro-arterio-myo-synangiosis. Childs Nerv Syst. 1997. 01. 13(1):24–29.
Article
9. Ishii R. [Surgical treatment of moyamoya disease]. No Shinkei Geka. 1986. 08. 14(9):1059–1068. Japanese.
10. Ishikawa T, Kamiyama H, Kuroda S, Yasuda H, Nakayama N, Takizawa K. Simultaneous superficial temporal artery to middle cerebral or anterior cerebral artery bypass with pan-synangiosis for Moyamoya disease covering both anterior and middle cerebral artery territories. Neurol Med Chir (Tokyo). 2006. 09. 46(9):462–468.
11. Karasawa J, Kikuchi H, Furuse S, Kawamura J, Sakaki T. Treatment of moyamoya disease with STA-MCA anastomosis. J Neurosurg. 1978. 11. 49(5):679–688.
Article
12. Karasawa J, Kikuchi H, Furuse S, Sakaki T, Yoshida Y. A surgical treatment of moyamoya disease encephalo-myo synangiosis. Neurol Med Chir (Tokyo). 1977. 17(1 Pt 1):29–37.
Article
13. Kashiwagi S, Kato S, Yamashita K, Takasago T, Akimura T, Okamura S, et al. Revascularization with split duro-encephalo-synangiosis in the pediatric moyamoya disease-surgical result and clinical outcome. Clin Neurol Neurosurg. 1997. 10. 99:Suppl 2. S115–S117.
Article
14. Kawaguchi T, Fujita S, Hosoda K, Shose Y, Hamano S, Iwakura M, et al. Multiple burr-hole operation for adult moyamoya disease. J Neurosurg. 1996. 03. 84(3):468–476.
Article
15. Kim DS, Kang SG, Yoo DS, Huh PW, Cho KS, Park CK. Surgical results in pediatric moyamoya disease: angiographic revascularization and the clinical results. Clin Neurol Neurosurg. 2007. 02. 109(2):125–131.
Article
16. Kim DS, Yoo DS, Huh PW, Kang SG, Cho KS, Kim MC. Combined direct anastomosis and encephaloduroarteriogaleosynangiosis using inverted superficial temporal artery-galeal flap and superficial temporal artery-galeal pedicle in adult moyamoya disease. Surg Neurol. 2006. 10. 66(4):389–394. discussion 395.
Article
17. Kim SH, Choi JU, Yang KH, Kim TG, Kim DS. Risk factors for postoperative ischemic complications in patients with moyamoya disease. J Neurosurg. 2005. 11. 103:5 Suppl. 433–438.
Article
18. Kinugasa K, Mandai S, Kamata I, Sugiu K, Ohmoto T. Surgical treatment of moyamoya disease: operative technique for encephalo-duro-arterio-myo-synangiosis, its follow-up, clinical results, and angiograms. Neurosurgery. 1993. 04. 32(4):527–531.
19. Kuroda S, Houkin K. Moyamoya disease: current concepts and future perspectives. Lancet Neurol. 2008. 11. 7(11):1056–1066.
Article
20. Lee JP, Cho SJ, Park HK, Park SQ, Chang JC, Choi SK. Angiographic and Clinical Results of Indirect Bypass Surgery for Moyamoya Disease. Korean J Cerebrovasc Surg. 2010. 12. 12(4):250–258.
21. Matsushima T, Fukui M, Kitamura K, Hasuo K, Kuwabara Y, Kurokawa T. Encephalo-duro-arterio-synangiosis in children with moyamoya disease. Acta Neurochir (Wien). 1990. 104(3-4):96–102.
Article
22. Park JH, Yang SY, Chung YN, Kim JE, Kim SK, Han DH, et al. Modified encephaloduroarteriosynangiosis with bifrontal encephalogaleoperiosteal synangiosis for the treatment of pediatric moyamoya disease. Technical note. J Neurosurg. 2007. 03. 106:3 Suppl. 237–242.
23. Starke RM, Komotar RJ, Connolly ES. Optimal surgical treatment for moyamoya disease in adults: direct versus indirect bypass. Neurosurg Focus. 2009. 04. 26(4):E8.
Article
24. Suzuki J, Takaku A. Cerebrovascular moyamoya disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol. 1969. 03. 20(3):288–299.
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