Hiroyuki Katano1, Yusuke Nishikawa2, Hiroshi Yamada2, Teishiki Shibata2, Shigenori Miyachi3, Mitsuhito Mase2. 1. Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Medical informatics & Integrative Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. Electronic address: katano@med.nagoya-cu.ac.jp. 2. Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 3. Department of Central Radiology, Nagoya City University Hospital, Nagoya, Japan.
Abstract
BACKGROUND: The underlying mechanisms of headache in adult moyamoya disease (MMD) are not clear. The aim of this study is to clarify the factors that are associated with headache in adult patients with MMD after superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. METHODS: We retrospectively analyzed the cases of 68 adult patients with MMD: 30 with surgery and 38 without surgery. Each STA-MCA anastomosis was performed by the standard technique. Magnetic resonance angiography (MRA) and single photon emission computed tomography were performed perioperatively. We stratified the intensity and frequency of the patients' headaches into 4 ranks. Pre- and postoperative STA diameters were retrospectively measured on digital subtraction angiography (DSA) and/or MRA. RESULTS: In the surgery group, preoperative regional cerebral blood flow (rCBF) laterality and a postoperative rCBF increase >20% showed no significant difference between the patients with and without headache with a univariate analysis. The postoperative STA diameters of the distal branch (DSA) and main trunk (DSA/MRA) in the patients with headache were significantly larger than those of the patients without headache. The rate of postoperative increase of the STA diameters of the distal branch/main trunk was also significantly higher in the patients with headache than those without headache. A multivariate analysis showed that the standard regression coefficient β for sex, a >20% increase of postoperative rCBF, and the increase rate of the STA diameter of the distal branch shown by DSA was 0.37, 0.54, and 0.56, respectively. CONCLUSIONS: The results of our analyses revealed that aside from ischemia, the postoperative increase rate of the STA may be a candidate reason for headache, especially in adult patients with MMD.
BACKGROUND: The underlying mechanisms of headache in adult moyamoya disease (MMD) are not clear. The aim of this study is to clarify the factors that are associated with headache in adult patients with MMD after superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. METHODS: We retrospectively analyzed the cases of 68 adult patients with MMD: 30 with surgery and 38 without surgery. Each STA-MCA anastomosis was performed by the standard technique. Magnetic resonance angiography (MRA) and single photon emission computed tomography were performed perioperatively. We stratified the intensity and frequency of the patients' headaches into 4 ranks. Pre- and postoperative STA diameters were retrospectively measured on digital subtraction angiography (DSA) and/or MRA. RESULTS: In the surgery group, preoperative regional cerebral blood flow (rCBF) laterality and a postoperative rCBF increase >20% showed no significant difference between the patients with and without headache with a univariate analysis. The postoperative STA diameters of the distal branch (DSA) and main trunk (DSA/MRA) in the patients with headache were significantly larger than those of the patients without headache. The rate of postoperative increase of the STA diameters of the distal branch/main trunk was also significantly higher in the patients with headache than those without headache. A multivariate analysis showed that the standard regression coefficient β for sex, a >20% increase of postoperative rCBF, and the increase rate of the STA diameter of the distal branch shown by DSA was 0.37, 0.54, and 0.56, respectively. CONCLUSIONS: The results of our analyses revealed that aside from ischemia, the postoperative increase rate of the STA may be a candidate reason for headache, especially in adult patients with MMD.