Reconstructive Operation for Moyamoya Disease

Abstract

The authors experienced 14 operative cases with moyamoya disease (3 children and 11 adults). Presenting symptoms were hemorrhagic attack alone in 6 cases, hemorrhagic attack and ischemic episode at different times in 2 cases, and ischemic attack alone in 6 cases. Out of 14, 12 subjects underwent bilateral operations and 2 were operated unilaterally. In total, 26 sides were operated and operative methods consisted of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis alone in 11 sides, STA-MCA anastomosis with encephalo-myo-synangiosis (EMS) in 6 sides, and EMS alone in 9 sides. Encephalo-arterio-synangiosis (EAS), named by the authors, was performed in 2 cases as a supplementary operation. Follow-up periods ranged from 1 to 44 months (average 24 months). Outcomes were “excellent” in 9, “good” in 4, “good” followed by “dead” in one. Out of 8 subjects who presented hemorrhagic attack before the operation, 2 cases showed another minor hemorrhagic attack 30 months and 31 months, respectively, following STA-MCA anastomoses. The relationship between absence of reduction of moyamoya vessels following surgery and repeated bleeding, and the surgical indication for the hemorrhagic type were discussed. STA-MCA anastomosis with EMS (and EAS) seemed to be the most preferable operative method at present.