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Acta Neurochirurgica

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01-02-2013 | Clinical Article - Vascular

Adult moyamoya after revascularization

Authors: Bradley A. Gross, Rose Du

Published in: Acta Neurochirurgica | Issue 2/2013

Abstract

Background

Although cerebral revascularization is an accepted treatment for moyamoya, the precise impact of direct or indirect bypass methods on subsequent event rates is infrequently addressed in adult cohorts.

Methods

We reviewed 45 consecutive adults with 69 hemispheres affected by moyamoya. We evaluated stroke and hemorrhage rates prior to and following revascularization.

Results

Direct revascularization was performed for 35 hemispheres (51 %) in 29 patients (64 %). The annual stroke, hemorrhage and overall event rates in this cohort diminished from 8.9 %, 2.0 %, and 11 % per hemisphere-year to 4.5 %, 0 %, and 4.5 % per hemisphere-year after treatment, respectively (p = 0.06). Excluding perioperative events, no events occurred over 41.1 hemisphere-years of follow-up (p = 0.0017). After a mean clinical follow-up period of 1.3 years, 72 % of patients were improved, 24 % the same, and 3 % worse in this cohort. Indirect revascularization was performed for 18 hemispheres (26 %) in 13 patients (29 %). The annual stroke, hemorrhage and overall event rates were 13 %, 0 %, and 13 % per hemisphere-year prior to treatment, and 6.8 %, 4.5 %, and 11 % per hemisphere-year after treatment, respectively (p = 0.67). Excluding perioperative events, the overall annual event rate was 7.1 % (p = 0.69). After a mean clinical follow-up of 2.7 years, 46 % of patients were improved, 38 % were the same and 15 % were worse.

Conclusion

Direct revascularization is the optimal choice to prevent subsequent events in adult patients with moyamoya. A favorable impact of indirect revascularization was less clear in this cohort, and should be reserved for patients with an inadequate donor vessel.

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Title: Adult moyamoya after revascularization
Authors: Bradley A. Gross
Rose Du
Publication date: 01-02-2013
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 2/2013
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-012-1545-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Adult moyamoya after revascularization

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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