Surgical Treatment of Juvenile Patients with Moyamoya Disease Based on Clinical Use of Hemodynamic Measurement

Keywords: Moya Moya Disease, vascular, surgery, stroke, outcome

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     Patients with moyamoya disease (MMD) commonly have steno-occlusive lesion in bilateral carotid system. Clinical presentation and severity of hemodynamic impairment, however, is highly variable.
     We reported our experience in treating juvenile patients with MMD by measuring hemodynamic condition and compared the result of such protocol with treatment based on angiographical finding.
     276 patients with MMD of 18 years or younger were treated from 1979 to June 2011.
     111 of them were treated based on the screening of cerebral hemodynamics with DSC-MRI and/or PET (CBF group). 165 were treated based on angiographical information (AG group). Result of treatment was compared between two groups.
     1) Rate of patients who underwent surgical treatment decreased (94.5 % in AG group vs 80.2 % in CBF group). 2) Rate of patients who received bilateral surgery as an initial treatment decreased (83.4% in AG group vs 58.4% in CBF group). 3) Rate of patients who received additional surgery contralateral to the initial surgery also decreased (46.2 % in AG group vs 35.1% in CBF group). 4) Rate of patients who received surgery at posterior third of cerebral hemisphere (parieto-occipital lobe and posterior temporal lobe) increased as an initial surgery (0.6 % in AG group vs 5.6 % in CBF group), and as an additional surgery (1.4 % in AG group vs 15.4 % in CBF group). 5) Perioerative infarction decreased slightly (4.6 % in AG group and 4.3 % in CBF group) 6) Surgical treatment during childhood completed in less than 4 years in both groups , but late onset worsening of symptom have come to occur in adulthoodin.
     This is a retrospective study.
     By using CBF measurement, surgical treatment of MMD were conducted on the selected area of brain of the selected patients.
     Late onset worsening of vessel occlusion in the posterior part of brain will be the matter to be followed up for both groups of patients.


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