title: Cerebral hemorrhage and cerebral infarction in 30 cases of adult moyamoya disease: comparison between conservative therapy and superficial temporal artery-middle cerebral artery anastomosis.
abstract: To clarify the effect of surgery on the prevention cerebral hemorrhage in adult moyamoya disease, we compared postoperative courses between superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and conservative therapy. The study subjects were 30 adults with moyamoya disease. Unilateral STA-MCA anastomosis was conducted in 7 of these 30 cases, and bilateral STA-MCA anastomosis was conducted in 8 of these 30 cases. Therefore, anastomosis was performed in a total of 23 sides. The postoperative clinical course was observed for more than 5 years after the STA-MCA anastomosis. Cerebral hemorrhage occurred after operation in 2 sides (8.7%) among the 23 sides that received STA-MCA anastomosis. On the contrary, hemorrhage occurred during conservative therapy in 5 sides (13.5%) among 37 non-operation sides (no significance in chi2 test). Cerebral infarction occurred in 3 sides (13%) among 23 sides treated with STA-MCA anastomosis. However, the infarction occurred in 2 sides (5.4%) among the 37 non-operation sides (no significance in chi2 test). Cerebral hemorrhage tended to occur less frequently after STA-MCA anastomosis, and bypass surgery was suggested to have some beneficial effect in preventing cerebral hemorrhage in adult moyamoya disease. However, it was revealed that STA-MCA anastomosis exacerbated the brain ischemia. Therefore, strict management is mandatory in the perioperative period.
authors.affiliation: Department of Neurosurgery, Ogaki Municipal Hospital, Ogaki, Japan. oya3776@arrow.ocn.ne.jp
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Oyama
authors.forename: Akira
authors.initials: A
authors.lastname: Kito
authors.forename: Hideki
authors.initials: H
authors.lastname: Maki
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hattori
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Noda
authors.forename: Kentaro
authors.initials: K
authors.lastname: Wada
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D002533:Cerebral Angiography / Q000379:methods; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D006801:Humans; D020768:Middle Cerebral Artery / Q000601:surgery*; D009072:Moyamoya Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D019635:Neurosurgical Procedures / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D012307:Risk Factors; D013699:Temporal Arteries / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
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