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Outcomes of Combined Revascularization Surgery for Moyamoya Disease without Preoperative Cerebral Angiography

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Title: Outcomes of Combined Revascularization Surgery for Moyamoya Disease without Preoperative Cerebral Angiography
Authors: Okuyama, Tomohiro Browse this author
Kawabori, Masahito Browse this author →KAKEN DB
Ito, Masaki Browse this author
Sugiyama, Taku Browse this author
Kazumata, Ken Browse this author
Fujimura, Miki Browse this author →KAKEN DB
Keywords: Cerebral infarction
Intracranial hemorrhage
Moyamoya disease
Vascular disorders
Issue Date: Sep-2022
Publisher: Elsevier
Journal Title: World neurosurgery
Volume: 165
Start Page: e446
End Page: e451
Publisher DOI: 10.1016/j.wneu.2022.06.067
Abstract: OBJECTIVE: Cerebral angiography is the gold standard for diagnosing moyamoya disease (MMD), whereas mag-netic resonance (MR) imaging/angiography is becoming more popular in the field of cerebrovascular disease due to its low invasiveness. Although there are concerns about using only MR imaging/angiography for preoperative analysis of MMD, considering the underestimation of pre-existing transdural collateral circulations and dangerous collaterals related to the risk of hemorrhage, we retro-spectively reviewed our 10-year experience of MR imagingefirst diagnosis and analyzed the perioperative outcomes.METHODS: We analyzed 160 consecutive direct/indirect combined revascularization procedures for MMD preoper-atively assessed using MR imaging/angiography alone. Perioperative complications were assessed for up to 2 weeks after surgery. Locations of the lesions responsible for complications were further classified into the surgical field, the ipsilateral hemisphere outside the surgical field, and the contralateral hemisphere.RESULTS: Sixty-four revascularization procedures were performed in 38 children, and 96 procedures were per-formed in 68 adults. There was no difference in the inci-dence of perioperative ischemic complications between adults (6.3%) and pediatric patients (4.7%), but hemorrhagic complications were more frequently observed in adults (7.3%) than in children (0%) (P < 0.05). There was no spe-cific lesion deviation for ischemic complications; however, hemorrhagic complications predominantly occurred in the surgical field. CONCLUSIONS: Direct/indirect combined revasculari-zation surgery based on our preoperative diagnostic pro-tocol with the MR-first strategy resulted in favorable outcomes in pediatric MMD patients with relatively low complication rates. However, the validity of the MR-first diagnostic protocol should be further evaluated in adult patients with MMD.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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