• World Neurosurg · Feb 2017

    Surgical outcome for Moyamoya disease - clinical and perfusion computed tomography correlation.

    • Alvin Ho-Kwan Cheung, Angus Ka-Cheong Lam, Wai-Shing Wilson Ho, Chun-Pong Tsang, Anderson Chun-On Tsang, Raymond Lee, Wai-Man Lui, and Gilberto Ka-Kit Leung.
    • Divsion of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong.
    • World Neurosurg. 2017 Feb 1; 98: 81-88.

    ObjectivesTo compare surgical outcome both radiologically and clinically after interventions for patients with Moyamoya disease.MethodsThis retrospective observational study included 25 patients who were treated surgically for Moyamoya disease in the past 14 years. Clinical outcomes were analyzed by subgroups stratified by age, disease presentation, and surgical intervention. Serial postoperative brain computed tomography perfusion records were analyzed with respect to the cerebral blood flow and cerebrovascular reserve capacity (CVRC) of the middle cerebral artery territory. Changes in both the intervention (n = 23) and nonintervtion (n = 9) cerebral hemispheres were compared.ResultsAll children treated by synangiosis (n = 9), all adults receiving synangiosis (n = 5), and 88.9% of adults undergoing bypass (n = 9) had no neurologic deterioration, with a duration of at least 50.6 months, 85.7 months, and 27.7 months, respectively. Radiologically, CVRC improved more markedly after bypass surgery than synangiosis, particularly 12-24 months postoperatively (51.1% vs. -2.86%). The hemispheres that did not undergo intervention showed similar improvement in cerebral blood flow over time compared with the hemispheres that did undergo intervention, after surgery was performed.ConclusionsBypass surgery improved CVRC greater than synangiosis, which may correlate with decreased future stroke risks. The decision for bypass is to be balanced with a greater risk of postoperative neurologic deterioration in adults after this procedure. The hemisphere that did not undergo intervention also appeared to benefit from surgery performed on the contralateral brain.Copyright © 2016 Elsevier Inc. All rights reserved.

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