gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Age dependent revascularization patterns in the treatment of Moyamoya disease in a European patient population

Meeting Abstract

  • M. Czabanka - Klinik für Neurochirurgie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
  • P. Schmiedek - Neurochirurgische Klinik, Klinikum Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg
  • P. Vajkoczy - Klinik für Neurochirurgie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin
  • P. Horn - Klinik für Neurochirurgie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.07-05

DOI: 10.3205/09dgnc157, URN: urn:nbn:de:0183-09dgnc1575

Published: May 20, 2009

© 2009 Czabanka et al.
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Outline

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Objective: Direct and indirect revascularisation procedures are applied to treat pediatric and adult Moyamoya disease patients. It was the aim of the current study to investigate and semiquantitatively analyse the relative contribution of direct and indirect revascularization procedures on the restoration of collateral blood supply in a European population of pediatric and adult MMD patients.

Methods: We performed 36 combined cerebral revascularization procedures (standard extra-intracranial bypass [STA-MCA bypass] + encephalomyosynangiosis [EMS]) in 10 pediatric (5 males/5 females, 40 hemispheres; mean age 9.7 years) and 10 adult (3 males/7 females, 19 hemispheres; mean age 37,2 years) MMD patients. All patients received digital subtraction angiography (DSA) before and follow-up DSA 6 months after surgery (6-54 months). STA-MCA bypass function was graded as follows: grade I = filling of the anastomosed MCA branch only, grade II = filling of 2 or more MCA branches, grade III = ante- and retrograde filling of the entire MCA system. EMS function was graded as follows: grade I = 0 vessels; grade II = 1–4 vessels; grade III = > 4 vessels.

Results: All hemispheres were MMD grade III or IV according to Suzuki grading system. In paediatric MMD patients follow-up DSA revealed bypass function grade I in 12 hemispheres (60%) and grade II in 8 hemispheres (40%) without any bypass procedure showing grade III function. EMS function was grade II in 12 hemispheres (60%) and III in 8 hemispheres (40%) without any EMS function showing grade I function. In the adult patients bypass function was grade I in 7 hemispheres (46%), grade II in 7 hemispheres (46%) and grade III in 1 hemisphere (7%). EMS was grade I in 10 hemispheres (66%), grade II in 4 hemispheres (27%) and grade III in 1 hemisphere (7%).

Conclusions: STA-MCA bypass achieved good angiographic revascularisation results in both patient populations. In paediatric patients indirect revascularisation using EMS represents a suitable, alternative revascularization procedure compared to direct bypass revascularization.