REVASCULARIZACION CEREBRAL EN EL MOYAMOYA DEL ADULTO

Abstract

Introduction: Moyamoya is a chronic steno-occlusive disease of the intracranial vessels associated to the secondary development of dilated arterioles at the base of the brain. The natural history of the disease predisposes to cerebral infarcts and/or hemorrhages. The objective of this paper is to show our experience and surgical management of adult moyamoya.

Materials and Methods: retrospective review of 11 adult patients with moyamoya treated from May 2014 to May 2020 was performed. Clinical charts, neuroimaging studies, operative records and surgical videos were analyzed. The Suzuki scale was used as a preoperative score, and the modified Rankin scale was used for pre and postoperative clinical assessment.

Results: Eleven patients (8 females) were operated at our Institution: 9 are MMD and 2 MMS secondary to NF1 and Hashimoto disease. We performed 16 cerebral revascularizations in 11 patients (in 5 patients the cerebral revascularization was bilateral), 12 were combined (STA-MCA bypass plus EDMS) and in only 4 EDAMS synangiosis was done.

The increase in cerebral blood flow was verified in all cases by follow-up DSA at 6 months. The STA-MCA bypass permeability was verified in 10 of 12 cases (83.3%) and the revascularization by synangiosis was demonstrated in all patients. Clinical follow-up showed that 82 % of the patients improved one point or more on the modified Rankin scale and one patient presented a frontal infarction on postoperative CT without clinical worsening.

Conclusions: The natural course of the disease leads to neurological deterioration due to ischemic and hemorrhagic stroke. According to our experience, the best therapeutic option in adults is combined cerebral revascularization because it decreases the incidence of stroke with good results and low morbidity.

Key words: moyamoya, cerebral revascularization, STA-MCA bypass, synangiosis

Abbreviations  

MM: moyamoya    MMD: moyamoya disease   MMS: moyamoya syndrome   NMR: nuclear magnetic resonance   MRA: magnetic resonance angio   DSA: digital subtraction angiography   EDMS: Encephaloduromyosynangiosis   EDAMS: Encephaloduroarteriomyosynangiosis    EGPS: Encephalogaleoperyostiosynangiosis   STA-MCA bypass: superficial temporal artery-middle cerebral artery bypass   CT scan: computer tomography   NF1: neurofibromatosis type 1