Surgical Outcome for Moyamoya Disease: Clinical and Perfusion Computed Tomography Correlation.
OBJECTIVE
To compare surgical outcome both radiologically and clinically after interventions for patients with Moyamoya disease.


METHODS
This retrospective observational study included 25 patients who were treated surgically for Moyamoya disease in the past 14 years. Clinical outcomes were analyzed by subgroups stratified by age, disease presentation, and surgical intervention. Serial postoperative brain computed tomography perfusion records were analyzed with respect to the cerebral blood flow and cerebrovascular reserve capacity (CVRC) of the middle cerebral artery territory. Changes in both the intervention (n = 23) and nonintervtion (n = 9) cerebral hemispheres were compared.


RESULTS
All children treated by synangiosis (n = 9), all adults receiving synangiosis (n = 5), and 88.9% of adults undergoing bypass (n = 9) had no neurologic deterioration, with a duration of at least 50.6 months, 85.7 months, and 27.7 months, respectively. Radiologically, CVRC improved more markedly after bypass surgery than synangiosis, particularly 12-24 months postoperatively (51.1% vs. -2.86%). The hemispheres that did not undergo intervention showed similar improvement in cerebral blood flow over time compared with the hemispheres that did undergo intervention, after surgery was performed.


CONCLUSIONS
Bypass surgery improved CVRC greater than synangiosis, which may correlate with decreased future stroke risks. The decision for bypass is to be balanced with a greater risk of postoperative neurologic deterioration in adults after this procedure. The hemisphere that did not undergo intervention also appeared to benefit from surgery performed on the contralateral brain.
Divsion of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong.
Alvin Ho-Kwan
AH
Cheung
Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong.
Angus Ka-Cheong
AK
Lam
Divsion of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong.
Wai-Shing Wilson
WW
Ho
Divsion of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong.
Chun-Pong
CP
Tsang
Divsion of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong.
Anderson Chun-On
AC
Tsang
Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong.
Raymond
R
Lee
Divsion of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong.
Wai-Man
WM
Lui
Divsion of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong. Electronic address: gilberto@hku.hk.
Gilberto Ka-Kit
GK
Leung
D000328:Adult; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D009072:Moyamoya Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D010477:Perfusion; D010841:Pia Mater / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Extracranial-intracranial bypass; Moyamoya disease; Perfusion computed tomography