Article
Comparison of direct and indirect cerebral revascularization for the treatment of Non-Japanese patients with moyamoya disease
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Published: | September 16, 2010 |
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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.