title: Surgical outcomes following encephaloduroarteriosynangiosis in North American adults with moyamoya.
abstract: OBJECTIVE
  Moyamoya disease/syndrome (MMD/S) is a progressive, occlusive vasculopathy of the intracranial vasculature that leads to ischemic and hemorrhagic strokes. Significant debate exists regarding the role of indirect cerebrovascular bypass surgery in its management. The authors review their institution's experience with indirect bypass in the surgical management of patients with MMD/S.
  
  
  METHODS
  The authors conducted a retrospective review of patients with MMD/S who underwent encephaloduroarteriosynangiosis (EDAS), a form of indirect bypass, from 1996 to 2013.
  
  
  RESULTS
  A total of 37 patients (52 hemispheres) underwent an EDAS procedure for MMD/S; 21 patients received revascularization of both hemispheres. Patients presented with the following: 49% with stroke, 35% with transient ischemic attack, 13% with hemorrhage, and 3% with seizure. The mean Suzuki grade was 3.46. The number of patients with a modified Rankin Scale score of 0-1 improved from 21 to 29 (p = 0.002) from the time of surgery to the time of last follow-up. The number of neurological events (i.e., transient ischemic attacks, strokes, and hemorrhages) decreased from a mean of 1.7 events per patient to 0.14 (p < 0.001). The mean length of follow-up was 32.8 months.
  
  
  CONCLUSIONS
  This series demonstrates that EDAS is an effective procedure for MMD/S in a North American cohort of patients.
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston;
authors.forename: Pankaj K
authors.initials: PK
authors.lastname: Agarwalla
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Stapleton
authors.forename: Michael T
authors.initials: MT
authors.lastname: Phillips
authors.forename: Brian P
authors.initials: BP
authors.lastname: Walcott
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Venteicher
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000517:prevention & control*; D002543:Cerebral Hemorrhage / Q000517:prevention & control*; D002548:Cerebral Revascularization / Q000379:methods*; D003399:Craniotomy / Q000379:methods*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000601:surgery*; D009656:North America; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: ECA = external carotid artery; EDAS; EDAS = encephaloduroarteriosynangiosis; ICA = internal carotid artery; LOS = length of stay; MCA = middle cerebral artery; MMD = moyamoya disease; MMD/S = moyamoya disease/syndrome; MMS = moyamoya syndrome; STA = superficial temporal artery; STL = superior temporal line; TIA = transient ischemic attack; bypass; hemorrhage; mRS = modified Rankin Scale; moyamoya; stroke; vascular disorders