Surgical Treatment of Moyanoya Disease

Kim, Soo Young; Chung, Seong Moon; Chang, Suk Choo

Abstract

Moyamoya disease is an unusual cerebrovascular disease that is characterized by progressive occlusion of major cerebral arteries and abnormal collateralization of intracranial blood flow. The etiology of this disorder remains unknown. The diagnosis of moyamoya disease is made on the basis of angiographic findings: In its early stage there is stenosis of the supraclinoid portion of the internal carotid artery, frequently bilaterally. Later, there is enlargement of extracranial transdural collateral circulation. Surgical treatment of moyamoya disease consists of either direct anastomosis surgery (STA-MCA anastomosis) or indirect anastomosis, includingencephaloduroarteriosynangiosis (EDAS), encephalomyosynangiosis (EMS), encephalomy- oarteriosynangiosis (EMAS), encephaloduroarterio-myosy- nangiosis (EDAMS), and omentum transplantation. Direct anastomosis is the immediately effective procedure, and it is effective in case of the acute occlusive case. But its disadvantage is high incidence of the neurological deficits due to temporary stasis of blood in the cortical arteries. The double or triple anastomosis is recommended for the multiple occlusive lesion. Additionally, in a young child it may be technically difficult because of the small caliber of the STA. Therefore, indirect anastomosis is a more popular procedure than direct anastomosis except actue infarct case. We have performed the surgical treatment for 15 cases with moyamoya disease. Improvement of clinical symtoms was obtained and postoperatively good collateral circulation was confirmed on the angiogram and brain SPECT. In conclusion, among various methods of indirect anastomosis, EDAS is a safe and effective revascularization procedure for most cases of moyamoya disease.