title: Effectiveness of superficial temporal artery-middle cerebral artery anastomosis in adult moyamoya disease: cerebral hemodynamics and clinical course in ischemic and hemorrhagic varieties.
abstract: OBJECTIVE
  The efficacy of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in adult moyamoya disease was evaluated by clinicopathophysiological studies.
  
  
  METHODS
  Fifteen patients with cerebral ischemic attacks (ischemia group) and 15 patients with intracranial hemorrhages (hemorrhage group) were investigated. Clinicoangiographic features and regional cerebral blood flow (rCBF) of the MCA territory were preoperatively and postoperatively investigated, and cortical arterial pressure (CAP) and anastomotic blood flow (AF) were intraoperatively measured.
  
  
  RESULTS
  In the ischemia group, the preoperative rCBF of 38.4 mL/100 g per minute was significantly increased to 42.1 mL/100 g per minute with a diminution of angiographic moyamoya vessels in 67% of patients after surgery. The mean CAP and AF were 25.6 mm Hg and 34.7 mL/min, respectively. Proximal and distal cerebral vascular resistance (PCVR = [Mean Systemic Arterial Blood Pressure-Mean CAP]/rCBF and DCVR = [Mean CAP/rCBF]) were 1.78 and 0.68, respectively. One patient died perioperatively as a result of intracerebral hemorrhage. During follow-up (mean, 67 months), 12 of 14 patients recovered without neurological deficits, 1 was moderately disabled because of the initial insult, and another patient experienced an intracerebral hemorrhage but recovered fully. In the hemorrhage group, the preoperative rCBF of 38.0 mL/100 g per minute was significantly increased to 42.7 mL/100 g per minute with a diminution of moyamoya vessels in 60% after surgery. The mean CAP and AF were 29.1 mm Hg and 24.1 mL/min, respectively. PCVR and DCVR were 1.72 and 0.77, respectively. One patient became hemiparetic because of perioperative intracerebral hemorrhage. During follow-up (mean, 94 months), 3 patients had fatal intracranial hemorrhages, 10 had good recoveries, and 2 had moderate disabilities.
  
  
  CONCLUSIONS
  This study revealed a high PCVR and a very low DCVR in both the ischemia and hemorrhage groups of patients. STA-MCA anastomosis partially normalized cerebral circulation and decreased moyamoya vessels but did not completely prevent rebleeding.
authors.affiliation: Department of Neurosurgery, Shimane Medical University, Izumo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Okada
authors.forename: T
authors.initials: T
authors.lastname: Shima
authors.forename: M
authors.initials: M
authors.lastname: Nishida
authors.forename: K
authors.initials: K
authors.lastname: Yamane
authors.forename: T
authors.initials: T
authors.lastname: Yamada
authors.forename: C
authors.initials: C
authors.lastname: Yamanaka
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001794:Blood Pressure; D002536:Cerebral Arteries / Q000601:surgery*; D002560:Cerebrovascular Circulation; D006801:Humans; D008875:Middle Aged; D009072:Moyamoya Disease / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D012039:Regional Blood Flow; D013699:Temporal Arteries / Q000601:surgery*; D014655:Vascular Resistance