gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Results of direct and indirect revascularization for adult European patients with moyamoya angiopathy

Die Resultate nach direkter und indirekter Revaskularisation bei erwachsenen europäischen Patienten mit Moyamoya Angiopathie

Meeting Abstract

  • corresponding author D. Hänggi - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
  • J. Mehrkens - Neurochirugische Klinik, Ludwig-Maximilians-Universität, München
  • R. Schmidt-Elsaesser - Neurochirugische Klinik, Ludwig-Maximilians-Universität, München
  • H.-J. Steiger - Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 10.168

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Hänggi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: There is little information concerning revascularization procedures in adult European patients with moyamoya disease. More data are available on juvenile European moyamoya angiopathy and its microsurgical therapies. This analysis summarizes our clinical experience in European adult patients with moyamoya angiopathy.

Methods: Nine adult European patients underwent surgical revascularization for moyamoya angiopathy between 1997and 2005. Mean age at presentation was 36 years (range 24-60 years). Seven were females and 2 males. Seven patients presented with ischemic episodes and 2 patients were admitted with a hemorrhagic onset. All patients were diagnosed routinely with preoperative angiography, CT/MRI scans and CBF measurements (HMPAO-SPECT and perfusion MRI). Indication for surgical revascularization was based on repeated ischemic episodes or hemorrhage from the pathological neovasculature. Direct EC-IC bypass was considered the primary surgical modality. In case of unsuitable donor or recipient arteries, encephalo-myo-synangiosis (EMS) was chosen as an indirect modality.

Results: In 6 patients angiography and CBF measurement demonstrated bilateral affection. Two patients underwent bilateral superficial temporal artery to middle cerebral artery (STA-MCA) bypass whereas 6 patients had a unilateral bypass procedure. A combination of STA-MCA bypass on one side with EMS on the other side was performed in 2 of these. Bilateral EMS was carried out in 1 patient. During the postoperative course we documented one deep hematoma after EC-IC bypass that was related to a hypertensive episode. After evacuation the patient developed well. Otherwise there were no procedure related complications. STA-MCA bypass patency was documented in all cases by DSA and/or duplex sonography. Clinical improvement was measurable in 6 patients after direct revascularization; one patient was unchanged whereas one patient deteriorated due to progressive disease. The patient with a bilateral EMS only showed no alteration. Follow-up CBF measurements done between 2 and 12 months showed variable improvement in directly revascularized hemispheres, but no change after EMS.

Conclusions: The current analysis confirms that direct EC-IC bypass is a feasible option for most cases of adult European moyamoya disease. Exact definition of long-term benefits would require a multicentric study. EMS appears to be of questionable value in the adult European population.