gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Comparison of direct and indirect cerebral revascularization for the treatment of moyamoya disease. A prospective clinical study

Direkte vs. indirekte zerebrale Revaskularisierung für die Behandlung der Moyamoya Erkrankung. Eine prospektive klinische Studie

Meeting Abstract

  • corresponding author P. G. Peña-Tapia - Neurochirurgische Klinik, Universitätsklinikum Mannheim
  • J. Scharf - Neuroradiologische Abteilung, Universitätsklinikum Mannheim
  • E. Münch - Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Mannheim
  • G. Schubert - Neurochirurgische Klinik, Universitätsklinikum Mannheim
  • P. Vajkoczy - Neurochirurgische Klinik, Charité - Universitätsmedizin Berlin
  • P. Schmiedek - Neurochirurgische Klinik, Universitätsklinikum Mannheim

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocP 057

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

Published: May 30, 2008

© 2008 Peña-Tapia 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: For moyamoya (MM) disease, cerebral revascularization represents the treatment of choice. Numerous surgical modifications which basically can be differentiated into direct and indirect arterial bypasses have been reported, but the superiority of one treatment option over the other has not been systematically studied.

Methods: Over a 2-year period 36 patients with symptomatic MM disease were prospectively recruited and analysed. According to clinical findings or preoperative Cerebral Blood Flow (CBF) studies, a STA-MCA anastomosis with an additional encephalomyosynangiosis (EMS) was performed on the more affected hemisphere, and an EMS only on the contralateral side. All patients were operated on both sides in one session. DSA follow-up studies were performed postoperative and at 6 and 12 months thereafter.

Results: We present the results of 22 patients who have completed their 12-month follow-up period. There were 15 female and 7 male patients with a mean age of 35 yrs. This series includes 5 children, two of them with MM syndrome. Preoperative CBF studies performed in 15 adults, revealed in all characteristic bilateral disturbances, supporting a hemodynamic cerebrovascular insufficiency. Early postoperative angiography (21 patients) revealed a patent bypass in 18 cases. At 6 months postoperatively an enlargement of the direct bypass was noted in 15 patients and two of the previously not patent bypasses were open at this time. One year after surgery bypass size remained stable in 12 patients, continued to increase in 5 patients and was smaller in 4 patients. EMS was functioning at 6 months postoperatively in 17 hemispheres with combined revascularization and in 16 hemispheres where only an EMS had been performed. At 12 months, EMS was found to be bilaterally unchanged in most patients. No correlation was found between the degree of EMS revascularization and age. One year after surgery, CBF findings demonstrated bilaterally improved reserve capacity in 10 patients, progressive deterioration on both sides in two, improvement just over the hemisphere with combined revascularization in one patient and over the hemisphere with EMS only in another. One child and one adult reported new TIA´s within the first 6 months postopreatively. A stable or improved clinical situation was found in 21 patients at 12 months postoperatively.

Conclusions: Both direct and indirect revascularization procedures for the treatment of MM disease are effective. The degreee of cerebral revascularization obtained with surgery reaches stability at 6 months postoperatively in most cases.