Peicong Ge1, Qian Zhang1, Xun Ye1, Xingju Liu1, Xiaofeng Deng1, Rong Wang1, Yan Zhang1, Dong Zhang1, Jizong Zhao2. 1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China; Department of Neurosurgery, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurosurgery, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China. 2. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China; Department of Neurosurgery, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurosurgery, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China. Electronic address: zhaojz205@yahoo.com.
Abstract
OBJECTIVE: To elucidate the clinical features, surgical treatment, and long-term outcome in elderly patients with moyamoya disease (MMD). METHODS: We retrospectively reviewed 87 elderly patients with MMD at Beijing Tiantan Hospital. Clinical features, radiologic findings, and outcomes were analyzed. RESULTS: The mean age at diagnosis was 54.0 ± 3.7 years. Familial occurrence was 2.3%. Underlying vascular risk factors was 74.7%. Infarction was the most common symptom in elderly MMD (40.2%). Most patients presented with Suzuki stage 4 or 5 MMD (51.2%). Posterior cerebral artery involvement was observed in 22 (25.3%) patients. The incidence of postoperative infarction or hemorrhages was 6.9%. Diabetes was identified as a predictor of adverse postoperative events. During the average follow-up of 35.5 ± 22.2 months, rebleeding in patients with hemorrhagic MMD was higher than in those with ischemic MMD (P < 0.05). What's more, the rate of perfusion improvement in surgically treated patients was higher than in conservatively treated patients 3 months after discharge (P < 0.05). CONCLUSIONS: Infarction was the most common symptom in elderly MMD. More vascular risk factors, a higher grade of Suzuki stage, fewer familial cases, and posterior cerebral artery involvement were observed in elderly patients with MMD. Diabetes was a risk factor of postoperative events for elderly patients. Hemorrhagic MMD had a higher rate of rebleeding than the ischemic type. Although surgical revascularization procedures can improve cerebral perfusion, further study is needed to determine whether surgical revascularization is effective in elderly patients or with certain techniques.
OBJECTIVE: To elucidate the clinical features, surgical treatment, and long-term outcome in elderly patients with moyamoya disease (MMD). METHODS: We retrospectively reviewed 87 elderly patients with MMD at Beijing Tiantan Hospital. Clinical features, radiologic findings, and outcomes were analyzed. RESULTS: The mean age at diagnosis was 54.0 ± 3.7 years. Familial occurrence was 2.3%. Underlying vascular risk factors was 74.7%. Infarction was the most common symptom in elderly MMD (40.2%). Most patients presented with Suzuki stage 4 or 5 MMD (51.2%). Posterior cerebral artery involvement was observed in 22 (25.3%) patients. The incidence of postoperative infarction or hemorrhages was 6.9%. Diabetes was identified as a predictor of adverse postoperative events. During the average follow-up of 35.5 ± 22.2 months, rebleeding in patients with hemorrhagic MMD was higher than in those with ischemic MMD (P < 0.05). What's more, the rate of perfusion improvement in surgically treated patients was higher than in conservatively treated patients 3 months after discharge (P < 0.05). CONCLUSIONS:Infarction was the most common symptom in elderly MMD. More vascular risk factors, a higher grade of Suzuki stage, fewer familial cases, and posterior cerebral artery involvement were observed in elderly patients with MMD. Diabetes was a risk factor of postoperative events for elderly patients. Hemorrhagic MMD had a higher rate of rebleeding than the ischemic type. Although surgical revascularization procedures can improve cerebral perfusion, further study is needed to determine whether surgical revascularization is effective in elderly patients or with certain techniques.
Authors: Ignazio G Vetrano; Anna Bersano; Isabella Canavero; Francesco Restelli; Gabriella Raccuia; Elisa F Ciceri; Giuseppe Faragò; Andrea Gioppo; Morgan Broggi; Marco Schiariti; Laura Gatti; Paolo Ferroli; Francesco Acerbi Journal: J Clin Med Date: 2021-05-25 Impact factor: 4.241