title: The efficacy of superficial temporal artery-middle cerebral artery anastomosis in patients with moyamoya disease complaining of severe headache.
abstract: OBJECTIVE
  Some patients with moyamoya disease complain of severe headache, which may be closely related to cerebral ischemia. The efficacy of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in these patients was evaluated by clinicoradiological studies.
  
  
  METHODS
  Of 117 consecutive patients with ischemic moyamoya disease, 25 complained mainly of severe headache (headache group) and 92 had no significant headache (nonheadache group). Intensity of headache was evaluated pre- and postoperatively. Furthermore, regional cerebral blood flow (rCBF) and cerebrovascular reactivity (CVR) were assessed pre- and postoperatively.
  
  
  RESULTS
  The headache group was significantly younger than the nonheadache group. In a group corrected for the age distribution, preoperative rCBF and CVR were similar in headache and nonheadache groups. After STA-MCA anastomosis, 16 patients with headache experienced complete relief from headache, 7 patients showed remarkable improvements and discontinued medications for headache, and the remaining 2 patients had some alleviation of headache but sometimes required medication. In the headache group, the postoperative rCBF was significantly greater than the preoperative value. The postoperative rCBF in this group was also significantly greater than the postoperative rCBF in the nonheadache group.
  
  
  CONCLUSIONS
  These data suggest that severe headache is one of the main symptoms in young patients with moyamoya disease probably related to cerebral circulatory disturbances. An STA-MCA anastomosis is effective in relieving headache in patients with ischemic moyamoya disease manifesting severe headache, probably by improving perfusion pressure and cerebral circulation.
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan. yokada@nij.twmu.ac.jp
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Okada
authors.forename: Takakazu
authors.initials: T
authors.lastname: Kawamata
authors.forename: Akitsugu
authors.initials: A
authors.lastname: Kawashima
authors.forename: Kohji
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ono
authors.forename: Tomokatsu
authors.initials: T
authors.lastname: Hori
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D002545:Brain Ischemia / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006261:Headache / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D009072:Moyamoya Disease / Q000150:complications*; D011859:Radiography; D012720:Severity of Illness Index; D013699:Temporal Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult