Document Detail


Clinical features, surgical treatment, and long-term outcome in adult patients with moyamoya disease. Clinical article.
MedLine Citation:
PMID:  19374496     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The object of this study was to report the clinical features, surgical treatment, and long-term outcomes in adults with moyamoya phenomenon treated at a single institution in the US.
METHODS: Forty-three adult patients with moyamoya disease (mean age 40 +/- 11 years [SD], range 18-69 years) were treated with encephaloduroarteriosynangiosis (EDAS). Neurologists examined patients pre- and postoperatively. Follow-up was obtained in person or by structured telephone interview (median 41 months, range 4-126 months). The following outcomes were collected: transient ischemic attack (TIA), infarction, graft collateralization, change in cerebral perfusion, and functional level according to the modified Rankin scale (mRS). Kaplan-Meier estimates of infarction risk were calculated for comparison of surgically treated and contralateral hemispheres.
RESULTS: The majority of patients were women (65%), were Caucasian (65%), presented with ischemic symptoms (98%), and had bilateral disease (86%). Nineteen patients underwent unilateral and 24 patients bilateral EDAS (67 treated hemispheres). Collateral vessels developed in 50 (98%) of 52 hemispheres for which imaging was available and there was evidence of increased perfusion on SPECT scans in 41 (82%) of the 50 hemispheres evaluated. Periprocedural infarction (< 48 hours) occurred in 3% of the hemispheres treated. In the follow-up period patients experienced 10 TIAs, 6 infarctions, and 1 intracranial hemorrhage. Although the hemisphere selected for surgery was based upon patients' symptoms and severity of pathology, the 5-year infarction-free survival rate was 94% in the surgically treated hemispheres versus < 36% in the untreated hemispheres (p = 0.007). After controlling for age and sex, infarction was 89% less likely to occur in the surgically treated hemispheres than in the contralateral hemispheres (hazard ratio 0.11, 95% CI 0.02-0.56). Thirty-eight (88%) of 43 patients had preserved or improved mRS scores, relative to baseline status.
CONCLUSIONS: In this mixed-race population of North American patients, indirect bypass promoted adequate pial collateral development and increased perfusion in the majority of adult patients with moyamoya disease. Patients had low rates of postoperative TIAs, infarction, and hemorrhage, and the majority of patients had preserved or improved functional status.
Authors:
Robert M Starke; Ricardo J Komotar; Zachary L Hickman; Yehuda E Paz; Angela G Pugliese; Marc L Otten; Matthew C Garrett; Mitchell S V Elkind; Randolph S Marshall; Joanne R Festa; Philip M Meyers; E Sander Connolly
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  111     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-02     Completed Date:  2009-11-17     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  936-42     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurological Surgery, Columbia University, New York, New York 10032, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Cerebral Infarction / epidemiology
Collateral Circulation / physiology
Female
Humans
Intracranial Hemorrhages / epidemiology
Ischemic Attack, Transient / epidemiology
Kaplan-Meier Estimate
Male
Middle Aged
Moyamoya Disease / physiopathology*,  radionuclide imaging,  surgery*
Neovascularization, Physiologic
Neurosurgical Procedures*
Phenotype
Postoperative Complications / epidemiology
Seizures / etiology
Stroke / epidemiology
Tomography, Emission-Computed, Single-Photon
Treatment Outcome
Young Adult
Grant Support
ID/Acronym/Agency:
UL1 RR025750/RR/NCRR NIH HHS; UL1 RR025750/RR/NCRR NIH HHS; UL1 RR025750-015976/RR/NCRR NIH HHS
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