Korean J Cerebrovasc Surg.  2007 Mar;9(1):14-19.

Effect of Direct Bypass on the Prevention of Hemorrhage in Patients with the Hemorrhagic Type of Moyamoya Disease

• Kim H
• Kim YW
• Joo WI
• Park HK
• Jo JK
• Lee KJ
• Rha HK
• Park CK

Abstract

OBJECTIVE
The authors evaluated the effect of direct bypass (superficial temporal artery-middle cerebral artery bypass) in the prevention of rebleeding episodes in patients suffering from hemorrhagic moyamoya disease by comparing this method with indirect bypass.
METHODS
Fifteen patients who had hemorrhagic moyamoya without aneurysm comprised the study group. The mean age of patients was 44.4 years and follow up period ranged from 0.8 to 7.1 years (mean; 3.61 years). Revascularization surgery was performed in 21 sides in 15 patients. Direct bypass was performed in 17 sides and indirect bypass in the other 4 sides.
RESULTS
During the follow-up period after the revascularization surgery, three sides (14.3%) of the 21 sides presented with rebleeding episode, one of 17 sides (mean follow-up periods; 2.94 years) treated with direct method and 2 of 4 sides (mean follow-up periods; 6.45 years) treated with indirect method. Kaplan-Meier analysis of rebleedingfree survival showed quite different between direct and indirect method but statistically insignificant (p=0.0541).
CONCLUSION
Direct bypass may reduce the risk of hemorrhage more effectively than indirect bypass. However, direct bypass cannot always prevent rebleeding.

Keyword

Hemorrhagic moyamoya disease; Rebleeding; Direct bypass

MeSH Terms

Aneurysm
Cerebral Arteries
Follow-Up Studies
Hemorrhage*
Humans
Kaplan-Meier Estimate
Moyamoya Disease*