title: Contralateral progression and its risk factor in surgically treated unilateral adult moyamoya disease with a review of pertinent literature.
abstract: BACKGROUND
  The fate of the contralateral unaffected side of the surgically treated unilateral moyamoya disease (MMD) in adults has not been well described due to the limited number of cases and the heterogeneous ages and treatment methods. The aim of this study was to evaluate the contralateral angiographic progression rate and its risk factors in homogeneous adult MMD patients who underwent surgical revascularization, with a review of pertinent literature.
  
  
  METHODS
  Forty-one surgically treated unilateral MMD patients were retrospectively evaluated. We reviewed medical and radiological records including data on gender, age, hypertension (HTN), smoking, familial MMD, presenting symptom, surgical method, Suzuki stage, and contralateral progression. Then, we conducted univariate and multivariate analyses to determine risk factors.
  
  
  RESULTS
  Six of the 41 cases (14.6%) exhibited contralateral progression during the mean follow-up of 34 months. Four of those six patients (66.7%) were asymptomatic. Additional revascularization surgery was performed in the two symptomatic patients. The presence of a contralateral angiographic abnormality on initial angiography was a statistically significant risk factor for progression (OR, 49.00; p = 0.04). Younger age at diagnosis (32.7 ± 7.8 years in progression group vs. 42.5 ± 10.3 years in non-progression group, p = 0.046) was statistically significant in the univariate analysis, but age was not a significant factor in the multivariate analysis (p = 0.82). Other variables, such as gender (p = 0.13), HTN (p = 0.24), smoking (p = 0.47), and familial MMD (p = 0.20), did not show statistical significance.
  
  
  CONCLUSIONS
  The presence of a contralateral angiographic abnormality on initial angiography was a significant risk factor for progression in surgically treated unilateral adult MMD. Consequently, patients with contralateral abnormalities should be monitored closely.
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
authors.forename: Sang Chul
authors.initials: SC
authors.lastname: Lee
authors.forename: Jin Sue
authors.initials: JS
authors.lastname: Jeon
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Young Seob
authors.initials: YS
authors.lastname: Chung
authors.forename: Jun Hyong
authors.initials: JH
authors.lastname: Ahn
authors.forename: Won-Sang
authors.initials: WS
authors.lastname: Cho
authors.forename: Young-Je
authors.initials: YJ
authors.lastname: Son
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Bang
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Kang
authors.forename: Chang Wan
authors.initials: CW
authors.lastname: Oh
mesh_terms: D000328:Adult; D002533:Cerebral Angiography / Q000379:methods; D002548:Cerebral Revascularization / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012196:Review Literature as Topic; D012307:Risk Factors; D016896:Treatment Outcome