もやもや病の治療戦略と長期予後  [in Japanese] Treatment Strategies and Long-term Prognosis in Moyamoya Disease  [in Japanese]

We review clinical results after surgical revascularization in 164 patients with moyamoya disease. The surgical procedures include superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and indirect synangiosis using STA, dura mater, temporal muscle and pericranium. There were no significant differences in the incidence of perioperative morbidity among surgical procedures. Indirect synangiosis induced surgical collaterals in most of the pediatric patients, but in only 60% of adult patients. Postoperative angiography and SPECT/PET studies revealed that the development of surgical collaterals through indirect synangiosis depended on the operated areas. During follow-up periods, 10 of 164 patients (6.1%) experienced ischemic (n=3) or hemorrhagic stroke (n=7) after surgery. Completed stroke and "small craniotomy" surgery were significantly associated with poor intellectual outcome in pediatric patients.