Won-Sang Cho1, Jeong Eun Kim2, Chang Hyeun Kim1, Seung Pil Ban1, Hyun-Seung Kang1, Young Je Son1, Jae Seung Bang1, Chul-Ho Sohn1, Jin Chul Paeng1, Chang Wan Oh1. 1. From the Departments of Neurosurgery (W.-S.C., J.E.K., C.H.K., S.P.B., H.-S.K., Y.J.S., J.S.B., C.W.O.), Radiology (C.-H.S.), and Nuclear Medicine (J.C.P.), Seoul National University College of Medicine, Seoul, Korea. 2. From the Departments of Neurosurgery (W.-S.C., J.E.K., C.H.K., S.P.B., H.-S.K., Y.J.S., J.S.B., C.W.O.), Radiology (C.-H.S.), and Nuclear Medicine (J.C.P.), Seoul National University College of Medicine, Seoul, Korea. eunkim@snu.ac.kr.
Abstract
BACKGROUND AND PURPOSE: The surgical outcomes of adult moyamoya disease are rarely reported. We aimed to evaluate the long-term outcomes of combined revascularization surgery in patients with adult moyamoya disease. METHODS: Combined revascularization surgery consisting of superficial temporal artery-middle cerebral artery anastomosis with encephalodurogaleosynangiosis was performed on 77 hemispheres in 60 patients. Clinical, angiographic, and hemodynamic states were evaluated retrospectively using quantitative methods preoperatively and postoperatively in the short-term (≈6 months) and long-term (≈5 years) periods. The mean clinical follow-up duration was 71.0±10.1 months (range, 60-104 months). RESULTS: Clinical status improved until 6 months after surgery and remained stable thereafter, as assessed by the Karnofsky Performance Scale and modified Rankin Scale. The revascularization area relative to supratentorial area significantly increased in the long-term period compared with that in the short-term period (54.8% versus 44.2%; P<0.001). Cerebral blood flow in the territory of the middle cerebral artery improved in the short-term period compared with that in the preoperative period (68.7 versus 59.1; considering blood flow of the pons as 50; P<0.001) and thereafter became stable (65.5 in the long term; P=0.219). The annual risks of symptomatic hemorrhage and infarction were 0.4% and 0.2%, respectively, in the operated hemispheres. CONCLUSIONS: Combined revascularization surgery resulted in satisfactory long-term improvement in clinical, angiographic, and hemodynamic states and prevention of recurrent stroke.
BACKGROUND AND PURPOSE: The surgical outcomes of adult moyamoya disease are rarely reported. We aimed to evaluate the long-term outcomes of combined revascularization surgery in patients with adult moyamoya disease. METHODS: Combined revascularization surgery consisting of superficial temporal artery-middle cerebral artery anastomosis with encephalodurogaleosynangiosis was performed on 77 hemispheres in 60 patients. Clinical, angiographic, and hemodynamic states were evaluated retrospectively using quantitative methods preoperatively and postoperatively in the short-term (≈6 months) and long-term (≈5 years) periods. The mean clinical follow-up duration was 71.0±10.1 months (range, 60-104 months). RESULTS: Clinical status improved until 6 months after surgery and remained stable thereafter, as assessed by the Karnofsky Performance Scale and modified Rankin Scale. The revascularization area relative to supratentorial area significantly increased in the long-term period compared with that in the short-term period (54.8% versus 44.2%; P<0.001). Cerebral blood flow in the territory of the middle cerebral artery improved in the short-term period compared with that in the preoperative period (68.7 versus 59.1; considering blood flow of the pons as 50; P<0.001) and thereafter became stable (65.5 in the long term; P=0.219). The annual risks of symptomatic hemorrhage and infarction were 0.4% and 0.2%, respectively, in the operated hemispheres. CONCLUSIONS: Combined revascularization surgery resulted in satisfactory long-term improvement in clinical, angiographic, and hemodynamic states and prevention of recurrent stroke.
Authors: Ronan J Doherty; John Caird; Darach Crimmins; Peter Kelly; Sean Murphy; Christopher McGuigan; Niall Tubridy; Mary D King; Bryan Lynch; David Webb; Desmond O'Neill; Dominick J H McCabe; Peter Boers; Mary O'Regan; Joan Moroney; David J Williams; Simon Cronin; Mohsen Javadpour Journal: Ir J Med Sci Date: 2020-06-19 Impact factor: 1.568