title: Long-term outcomes after combined revascularization surgery in adult moyamoya disease.
abstract: OBJECTIVE
  The surgical outcomes of adult moyamoya disease are rarely reported. We aimed to evaluate the long-term outcomes of combined revascularization surgery in patients with adult moyamoya disease.
  
  
  METHODS
  Combined revascularization surgery consisting of superficial temporal artery-middle cerebral artery anastomosis with encephalodurogaleosynangiosis was performed on 77 hemispheres in 60 patients. Clinical, angiographic, and hemodynamic states were evaluated retrospectively using quantitative methods preoperatively and postoperatively in the short-term (≈6 months) and long-term (≈5 years) periods. The mean clinical follow-up duration was 71.0±10.1 months (range, 60-104 months).
  
  
  RESULTS
  Clinical status improved until 6 months after surgery and remained stable thereafter, as assessed by the Karnofsky Performance Scale and modified Rankin Scale. The revascularization area relative to supratentorial area significantly increased in the long-term period compared with that in the short-term period (54.8% versus 44.2%; P<0.001). Cerebral blood flow in the territory of the middle cerebral artery improved in the short-term period compared with that in the preoperative period (68.7 versus 59.1; considering blood flow of the pons as 50; P<0.001) and thereafter became stable (65.5 in the long term; P=0.219). The annual risks of symptomatic hemorrhage and infarction were 0.4% and 0.2%, respectively, in the operated hemispheres.
  
  
  CONCLUSIONS
  Combined revascularization surgery resulted in satisfactory long-term improvement in clinical, angiographic, and hemodynamic states and prevention of recurrent stroke.
authors.affiliation: From the Departments of Neurosurgery (W.-S.C., J.E.K., C.H.K., S.P.B., H.-S.K., Y.J.S., J.S.B., C.W.O.), Radiology (C.-H.S.), and Nuclear Medicine (J.C.P.), Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Won-Sang
authors.initials: WS
authors.lastname: Cho
authors.affiliation: From the Departments of Neurosurgery (W.-S.C., J.E.K., C.H.K., S.P.B., H.-S.K., Y.J.S., J.S.B., C.W.O.), Radiology (C.-H.S.), and Nuclear Medicine (J.C.P.), Seoul National University College of Medicine, Seoul, Korea. eunkim@snu.ac.kr.
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Kim
authors.affiliation: From the Departments of Neurosurgery (W.-S.C., J.E.K., C.H.K., S.P.B., H.-S.K., Y.J.S., J.S.B., C.W.O.), Radiology (C.-H.S.), and Nuclear Medicine (J.C.P.), Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chang Hyeun
authors.initials: CH
authors.lastname: Kim
authors.affiliation: From the Departments of Neurosurgery (W.-S.C., J.E.K., C.H.K., S.P.B., H.-S.K., Y.J.S., J.S.B., C.W.O.), Radiology (C.-H.S.), and Nuclear Medicine (J.C.P.), Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Seung Pil
authors.initials: SP
authors.lastname: Ban
authors.affiliation: From the Departments of Neurosurgery (W.-S.C., J.E.K., C.H.K., S.P.B., H.-S.K., Y.J.S., J.S.B., C.W.O.), Radiology (C.-H.S.), and Nuclear Medicine (J.C.P.), Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Kang
authors.affiliation: From the Departments of Neurosurgery (W.-S.C., J.E.K., C.H.K., S.P.B., H.-S.K., Y.J.S., J.S.B., C.W.O.), Radiology (C.-H.S.), and Nuclear Medicine (J.C.P.), Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Young Je
authors.initials: YJ
authors.lastname: Son
authors.affiliation: From the Departments of Neurosurgery (W.-S.C., J.E.K., C.H.K., S.P.B., H.-S.K., Y.J.S., J.S.B., C.W.O.), Radiology (C.-H.S.), and Nuclear Medicine (J.C.P.), Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Bang
authors.affiliation: From the Departments of Neurosurgery (W.-S.C., J.E.K., C.H.K., S.P.B., H.-S.K., Y.J.S., J.S.B., C.W.O.), Radiology (C.-H.S.), and Nuclear Medicine (J.C.P.), Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chul-Ho
authors.initials: CH
authors.lastname: Sohn
authors.affiliation: From the Departments of Neurosurgery (W.-S.C., J.E.K., C.H.K., S.P.B., H.-S.K., Y.J.S., J.S.B., C.W.O.), Radiology (C.-H.S.), and Nuclear Medicine (J.C.P.), Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jin Chul
authors.initials: JC
authors.lastname: Paeng
authors.affiliation: From the Departments of Neurosurgery (W.-S.C., J.E.K., C.H.K., S.P.B., H.-S.K., Y.J.S., J.S.B., C.W.O.), Radiology (C.-H.S.), and Nuclear Medicine (J.C.P.), Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chang Wan
authors.initials: CW
authors.lastname: Oh
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000098:blood supply; D002548:Cerebral Revascularization; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: adult; assessment, outcomes; combined revascularization surgery; moyamoya disease