Specific Shrinkage of Carotid Forks in Moyamoya Disease: A Novel Key Finding for Diagnosis

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Author(s)

    • KURODA Satoshi
    • Department of Neurosurgery, Graduate School of Medicine and Pharmacological Sciences, University of Toyama
    • KUWAYAMA Naoya
    • Department of Neurosurgery, Graduate School of Medicine and Pharmacological Sciences, University of Toyama
    • KASHIWAZAKI Daina
    • Department of Neurosurgery, Graduate School of Medicine and Pharmacological Sciences, University of Toyama
    • AKIOKA Naoki
    • Department of Neurosurgery, Graduate School of Medicine and Pharmacological Sciences, University of Toyama
    • KOH Masaki
    • Department of Neurosurgery, Graduate School of Medicine and Pharmacological Sciences, University of Toyama
    • HORI Emiko
    • Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital
    • UMEMURA Kimiko
    • Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital
    • HORIE Yukio
    • Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital
    • NOGUCHI Kyo
    • Department of Radiology, Graduate School of Medicine and Pharmacological Sciences, University of Toyama

Abstract

This study was aimed to analyze the outer diameter of the involved arteries in moyamoya disease, using three-dimensional (3D) constructive interference in steady state (CISS) and direct surgical inspection. Radiological evaluation was performed in 64 patients with moyamoya disease. As the controls, six patients with severe middle cerebral artery (MCA) stenosis and 17 healthy subjects were also recruited. On 3D-CISS, the outer diameter was quantified in the supraclinoid portion of internal carotid artery (C1), the horizontal portions of MCA (M1) and anterior cerebral artery (A1), and basilar artery. The involved carotid fork was directly observed during surgery in another series of three adult patients with moyamoya disease. In 53 adult patients with moyamoya disease, the outer diameters of C1, M1, and A1 segments were 2.3 ± 0.7 mm, 1.3 ± 0.5 mm, and 1.0 ± 0.4 mm in the involved side (n = 91), being significantly smaller than the control (n = 17), severe M1 stenosis (n = 6), and non-involved side in moyamoya disease (n = 15, P < 0.01). There were significant correlations between Suzuki's angiographical stage and the outer diameters of C1, M1, and A1 (P < 0.001). The laterality ratio of C1 and M1 was significantly smaller in unilateral moyamoya disease (n = 20) than the controls and severe MCA stenosis (P < 0.01). Direct observations revealed a marked decrease in the outer diameter of the carotid fork (n = 3). These findings strongly suggest specific shrinkage of the involved arteries in moyamoya disease, which may provide essential information to distinguish moyamoya disease from other intracranial arterial stenosis and shed light on the etiology and novel diagnosis cue of moyamoya disease.

Journal

  • Neurologia medico-chirurgica

    Neurologia medico-chirurgica 55(10), 796-804, 2015

    The Japan Neurosurgical Society

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