title: Long-term outcomes in adult patients with ischemic-type moyamoya disease involving posterior circulation.
abstract: BACKGROUND
  The object of this study was to compare the long-term outcomes in adult patients with moyamoya disease (MMD) with posterior circulation involvement (PCi) treated through surgical revascularization with those in adult patients without PCi.
  
  
  METHODS
  The records of 32 consecutive adult patients with ischemic-type MMD who were treated with revascularization were reviewed. Twelve of these patients (38 %) had PCi at initial onset. Clinical characteristics of the patients with PCi were compared to those without PCi. Neurological outcomes were assessed using the modified Rankin Scale (mRS) in the preoperative and postoperative follow-up periods. A five-year Kaplan-Meier stroke risk was calculated.
  
  
  RESULTS
  The frequency of presenting with infarction was significantly higher among patients with PCi than among those without PCi (p = 0.006). mRS scores in the preoperative period were significantly higher in patients with PCi than in patients without PCi (p = 0.0004). There were no significant differences in mRS scores between the preoperative and postoperative follow-up period in patients with PCi (p = 0.3), nor were there any between the preoperative and postoperative follow-up periods in patients without PCi (p = 0.2). The five-year Kaplan-Meier risk of surgical morbidity and ipsilateral stroke was 14.3 % in surgically treated hemispheres with PCi versus 14.9 % in surgically treated hemispheres without PCi (p = 0.96).
  
  
  CONCLUSIONS
  PCi at initial onset was significantly correlated with poor outcome. Revascularization for the middle cerebral artery territory in patients with PCi was effective at preventing recurrent ischemic stroke.
authors.affiliation: Department of Neurological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan, t-hishi@md.okayama-u.ac.jp.
authors.forename: Tomohito
authors.initials: T
authors.lastname: Hishikawa
authors.forename: Koji
authors.initials: K
authors.lastname: Tokunaga
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugiu
authors.forename: Isao
authors.initials: I
authors.lastname: Date
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D038524:Diffusion Magnetic Resonance Imaging; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020762:Infarction, Posterior Cerebral Artery / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome