title: Long-term follow-up results in 142 adult patients with moyamoya disease according to management modality.
abstract: BACKGROUND
  To clarify the most beneficial treatment of the management modality based on our experience with adult moyamoya disease (MMD).
  
  
  METHODS
  From 1998 to 2010, clinical results of 142 patients (ischemic, 98; hemorrhagic, 44) with adult MMD were investigated according to management modality. Revascularization surgery (direct, indirect, and combined bypass) was performed in 124 patients. We observed the clinical course of 18 patients who were treated conservatively. Clinical outcome, angiographic features, hemodynamic change, and incidence of recurrent stroke were investigated pre- and postoperatively.
  
  
  RESULTS
  In patients with ischemic MMD, direct and combined bypasses were more effective treatments to prevent recurrent ischemic stroke than indirect bypass surgery (P < 0.05). In patients with hemorrhagic MMD, rebleeding was less likely to occur in patients who had undergone bypass surgery. However, no significant difference was observed in the rebleeding rate between patients with and without revascularization surgery (P > 0.05). An angiogram after bypass surgery comparing the extent of revascularization and reduction of moyamoya vessels in patients treated with direct, indirect, and combined bypass showed a significant difference (P < 0.05) in favor of direct and combined bypass. Postoperative angiographic changes and SPECT results demonstrated significant statistical correlation (P < 0.05).
  
  
  CONCLUSIONS
  Revascularization surgery was effective in further ischemic stroke prevention to a statistically significant extent. Direct and combined bypasses were more effective to prevent recurrent ischemic stroke than indirect bypass. However, there is still no clear evidence that revascularization surgery significantly prevents rebleeding in adult MMD patients. More significant angiographic changes were observed in direct and combined bypasses compared with indirect bypass.
authors.affiliation: Department of Neurosurgery, Uijongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine, Uijongbu, 480-130, Korea.
authors.forename: Sang-Bok
authors.initials: SB
authors.lastname: Lee
authors.forename: Dal-Soo
authors.initials: DS
authors.lastname: Kim
authors.forename: Pil-Woo
authors.initials: PW
authors.lastname: Huh
authors.forename: Do-Sung
authors.initials: DS
authors.lastname: Yoo
authors.forename: Tae-Gyu
authors.initials: TG
authors.lastname: Lee
authors.forename: Kyoung-Suok
authors.initials: KS
authors.lastname: Cho
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D002548:Cerebral Revascularization / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D012008:Recurrence; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*