• World Neurosurg · Sep 2024

    Characterizing Revascularization after Encephalo-Duro-Arterio-Synangiosis (EDAS) in Adult Patients with Moyamoya Disease Using the Orbital Grading System.

    • Omar Alwakaa, Alejandro Enriquez-Marulanda, Felipe Ramirez-Velandia, Jean Filo, Emmanuel Mensah, Aryan Wadhwa, Thomas B Fodor, Samuel D Pettersson, Evan Paul McNeil, Michael Young, Sandeep Muram, Alfred P See, Justin H Granstein, Philipp Taussky, and Christopher S Ogilvy.
    • Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA.
    • World Neurosurg. 2024 Sep 10.

    BackgroundThe Matsushima Grade has traditionally been used to evaluate vessel ingrowth from the STA after EDAS for MMD-patients. However, this grading is subjective and prone to measurement variability. Herein, we propose the orbital grading system quantifying leptomeningeal and burr hole-related vessel-ingrowth from the STA and/or MMA to the middle and anterior cerebral arteries post-EDAS in MMD patients.MethodsAn anatomical classification was developed by reference to two parallel vertical lines from the bony landmarks of the orbit, categorized from Grade 0-3. Regression models were used to compare clinical and functional outcomes of our grading system with the Matsushima scale.ResultsForty MMD patients, with median age of 48 years, mostly females (72.5%), were included. Presentation included ischemic events (65.0%), hemorrhage (22.5%), and seizures (7.5%). Most patients were categorized as Suzuki ≥ IV (69.5%). Fifty EDAS (89.9%) had concurrent burr holes placed (parietal and frontal regions). At a median follow-up of 13.7 months, collateral growth was graded as follows: grade 0 (6;10.8%), grade 1 (12;21.4%), grade 2 (23;41.1%) and grade 3 (15;26.8%). Linear regression showed similarities in the distribution between the orbital grading system and Matsushima grading (r=0.86;p<0.01). Ischemic events were fewer in hemispheres categorized as grade 2-3 compared to grade 0-1 (p=0.047) as well as in Matsushima grading A or B compared to C (p=0.047).ConclusionThe orbital grading system demonstrated agreement in identifying postoperative ischemic events as the Matsushima grade and provides a more practical and objective evaluation of collateral vessel ingrowth after EDAS with and without burr-holes.Copyright © 2024 Elsevier Inc. All rights reserved.

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