• Yukihiro Yamao, Jun C Takahashi, Takeshi Funaki, Yohei Mineharu, Takyuki Kikuchi, Tomohisa Okada, Kaori Togashi, and Susumu Miyamoto.
• Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: yyamao@kuhp.kyoto-u.ac.jp.
• World Neurosurg. 2020 Jan 1; 133: e716-e721.

BackgroundThe clinical significance of asymptomatic microbleeds in moyamoya disease remains unclear. The purpose of this study was to clarify the relationship between bypass surgery and the incidence of asymptomatic microbleeds.MethodsThis retrospective study included 142 adult patients (mean age, 37.7 ± 13.5 years) with moyamoya disease, 36 of whom (25.3%) underwent bypass surgery in childhood. Hemorrhagic onset was diagnosed in 31 patients (21.8%). The incidence of microbleeds was evaluated on T2*-weighted or susceptibility-weighted imaging from 3-T magnetic resonance imaging. The patients were subsequently categorized into MBs (microbleeds) or non-MBs groups. Because previous microbleeds potentially lead to hemorrhage, the MBs group was defined as patients with radiographic evidence of bleeding, including asymptomatic microbleeds and/or hemorrhagic onset. The association of baseline characteristics was evaluated.ResultsAsymptomatic microbleeds were detected in 38 patients (26.8%). Of 31 patients with hemorrhagic onset, 18 had microbleeds, whereas 13 had no microbleeds. Therefore, 51 patients (35.9%) were classified into the MBs group. Bypass surgery in childhood (MBs, 7.8% vs. non-MBs, 35.2%; P < 0.01) and age (MBs, 42.9 ± 1.8 years vs. non-MBs, 34.7 ± 1.4 years; P < 0.01) were statistically significant factors associated with microbleeds, but only bypass surgery in childhood remained statistically significant after multivariable adjustment (odds ratio, 0.25; 95% confidence interval, 0.07-0.87; P = 0.03).ConclusionsThis study shows the clinical significance of revascularization surgery in childhood associated with a low incidence of asymptomatic microbleeds in adult patients with moyamoya disease. This finding indicates that a newly established bypass can reduce hemodynamic overstress.Copyright © 2019 Elsevier Inc. All rights reserved.

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