title: Universal Bypass for Treatment of Symptomatic Moyamoya Disease or Moyamoya Syndrome. Analysis of a Personal Case Series on Behalf of the Italian Moyamoya Association.
abstract: Moyamoya (MM) is a very rare cerebrovascular disease, particularly in Caucasians. We describe the results of an Italian case series where the mainstay of treatment was a bypass or a combined approach.
  
  
  
  An analysis of a prospectively collected database was carried out. The main objective was to investigate (1) the risk of perioperative stroke and surgical complications, (2) the risk of new ischemic events, and (3) the risk of new hemorrhages at follow-up (mean follow-up: 2.2 years).
  
  
  
  Between January 2011 and January 2015 we carried out 34 bypasses in 23 patients with MM (15 MM disease, 5 unilateral MM, 3 MM syndrome); mean age was 34 (range:1-57). The mortality and definitive morbidity rates were 0 %. Two patients suffered from transient aphasia and one developed partial palsy of the facial nerve. Five of the 12 patients with preoperative fixed deficits improved. No patient with preoperative ischemia experienced new ischemic symptoms. Rebleeding occurred in 1 of the 11 patients with a hemorrhagic presentation (9 %).
  
  
  
  The bypass/combined approach to MM appears to have a favorable risk profile and preventive effectiveness, particularly on TIAs and ischemic stroke.
authors.affiliation: Department of Neuroscience and Surgery of the Nervous System, Papa Giovanni XXIII Hospital, Bergamo, Italy. l.lanterna@gmail.com.
authors.forename: Luigi A
authors.initials: LA
authors.lastname: Lanterna
authors.affiliation: Department of Neuroscience and Surgery of the Nervous System, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Brembilla
authors.affiliation: Department of Anesthesia - Anesthesia and Intensive Care IV, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gritti
authors.affiliation: Department of Neuroscience and Surgery of the Nervous System, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bernucci
mesh_terms: D000293:Adolescent; D000328:Adult; D001037:Aphasia / Q000453:epidemiology; D002545:Brain Ischemia / Q000517:prevention & control*; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D002548:Cerebral Revascularization; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005155:Facial Nerve Diseases / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D002546:Ischemic Attack, Transient / Q000517:prevention & control*; D007558:Italy; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cerebral bypass; Moyamoya; STA-ACA bypass; STA-MCA bypass