Artikel
Age dependent revascularization patterns in the treatment of Moyamoya disease in a European patient population
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Veröffentlicht: | 20. Mai 2009 |
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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.