Artikel
Posterior circulation involvement in European moyamoya angiopathy: Presentation and management
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Autoren
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Constantin Roder
- Department of Neurosurgery, University of Tübingen
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Florian Ebner
- Department of Neurosurgery, University of Tübingen
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Gerasimos Baltsavias
- Department of Neuroradiology, University Hospital of Zürich, Switzerland
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Ulrike Ernemann
- Department of Neuroradiology, University of Tübingen
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Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen
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Nadia Khan
- Department of Neurosurgery, University of Tübingen; Moyamoya Center, Division of Pediatric Surgery, Department of Surgery, University Children’s Hospital, Zürich, Switzerland
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
Text
Objective: The posterior circulation is often overlooked in moyamoya angiopathy. We present the clinical, neuroradiological findings and neurosurgical management of European moyamoya patients presenting with a stenosis/occlusion of the posterior cerebral artery (PCA).
Method: Specific analysis of the full diagnostic results (cerebral angiography, MRI, H215O-PET CT, clincial parameters) of fifty two patients with Moyamoya angiopathy was performed to evaluate the role of posterior circulation involvement.
Results: Fifty two patients with newly diagnosed moyamoya (between 2011-2014) underwent cerebral angiography, MRI and H215O-PET examinations as part of their initial management workup. There were 36 children and 16 adults. Mean age of children was 3.5 years (0.6 to 8 years) and adults was 45 years (22 to 59 years). Eleven children (31%) and 4 adults (25%) showed stenosis/occlusion of the PCA in addition to changes in the MCA (middle cerebral artery) and/or ACA (anterior cerebral artery) territories. In 5 children these changes were bilateral. Adults showed a unilateral presentation. Six children (3 bilateral, 3 unilateral) showed partial or complete cortical infarcts in the PCA region, while in only one adult patient a subcortical watershed ischemia was observed. Cerebral perfusion reserves were decreased in respective PCA territories in 9/11 children and 1/4 adults. PCA territory revascularisation was carried out in the non infracted PCA regions in 8 children and 1 adult. No peri- or postoperative complications were observed.
Conclusions: Involvement of the posterior circulation in moyamoya in addition to the anterior circulation is reiterated. This is observed more frequently in children than in adults and is more severe in presentation. Stenosis/occlusion of the PCA must be examined neuroradiologically in all moyamoya patients and revascularization should be performed in non-infarcted regions with a clear reduction in perfusion reserves.
