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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

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Comparison of direct and indirect cerebral revascularization for the treatment of Non-Japanese patients with moyamoya disease

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  • Marcus Czabanka - Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Germany
  • Pablo Peña-Tapia - Department of Neurosurgery, Klinikum Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
  • Johannes Scharf - Department of Neuroradiology. Klinikum Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
  • Gerrit Alexander Schubert - Department of Neurosurgery, Klinikum Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
  • Elke Münch - Deparment of Anaesthesiology, Klinikum Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
  • Peter Horn - Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Germany
  • Peter Vajkoczy - Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Germany
  • Peter Schmiedek - Department of Neurosurgery, Klinikum Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1528

doi: 10.3205/10dgnc005, urn:nbn:de:0183-10dgnc0055

Published: September 16, 2010

© 2010 Czabanka et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The best revascularization strategy for Moyamoya Disease (MMD) remains unknown. It was the aim to characterize a bilateral, standardized revascularization approach consisting of STA-MCA bypass/encephalomyosynangiosis (EMS) on the symptomatic and single EMS on the contralateral hemisphere and to compare the efficacy for restoring cerebral hemodynamics.

Methods: In 30 consecutive patients (18 female/12 male, age range 8–63 years) standardized revascularization was performed. DSA was performed preoperatively and at 7 days, 6 months and 12 months postoperatively. STA-MCA and EMS function were graded I (poor), II (medium) and III (extensive) according to angiographic aspects. In 20 patients cerebrovascular reserve capacity (CVRC) was assessed pre- and postoperatively (at 12 months) using Xenon-CT.

Results: In a combined approach STA-MCA / EMS function was grade 1 in 40%/40%, grade 2 in 27%/26% and grade 3 in 27%/10% of hemispheres respectively. Single EMS revascularization showed grade I in 37%, grade II in 27% and grade III in 20% of hemispheres. Combined revascularization improved CVRC significantly compared to preoperative measurement (Preop:16,5±34,6 % vs. Postop: 60,8±64,22%; p<0,05). Single EMS did not improve CVRC significantly (Preop: 21,8±35,9 % vs. Postop: 34,8±63,0%; p<0,05).

Conclusions: Combined and indirect revascularization may be successfully applied in a bilateral standardized approach with providing sufficient collateral blood flow leading to clinical stabilization of the disease. Combined revascularization is superior to single EMS in restoring CVRC.