title: Clinical Features, Surgical Treatment, and Long-Term Outcome in Elderly Patients with Moyamoya Disease.
abstract: OBJECTIVE
  To elucidate the clinical features, surgical treatment, and long-term outcome in elderly patients with moyamoya disease (MMD).
  
  
  METHODS
  We retrospectively reviewed 87 elderly patients with MMD at Beijing Tiantan Hospital. Clinical features, radiologic findings, and outcomes were analyzed.
  
  
  RESULTS
  The mean age at diagnosis was 54.0 ± 3.7 years. Familial occurrence was 2.3%. Underlying vascular risk factors was 74.7%. Infarction was the most common symptom in elderly MMD (40.2%). Most patients presented with Suzuki stage 4 or 5 MMD (51.2%). Posterior cerebral artery involvement was observed in 22 (25.3%) patients. The incidence of postoperative infarction or hemorrhages was 6.9%. Diabetes was identified as a predictor of adverse postoperative events. During the average follow-up of 35.5 ± 22.2 months, rebleeding in patients with hemorrhagic MMD was higher than in those with ischemic MMD (P < 0.05). What's more, the rate of perfusion improvement in surgically treated patients was higher than in conservatively treated patients 3 months after discharge (P < 0.05).
  
  
  CONCLUSIONS
  Infarction was the most common symptom in elderly MMD. More vascular risk factors, a higher grade of Suzuki stage, fewer familial cases, and posterior cerebral artery involvement were observed in elderly patients with MMD. Diabetes was a risk factor of postoperative events for elderly patients. Hemorrhagic MMD had a higher rate of rebleeding than the ischemic type. Although surgical revascularization procedures can improve cerebral perfusion, further study is needed to determine whether surgical revascularization is effective in elderly patients or with certain techniques.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China; Department of Neurosurgery, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurosurgery, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Peicong
authors.initials: P
authors.lastname: Ge
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China; Department of Neurosurgery, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurosurgery, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China; Department of Neurosurgery, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurosurgery, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Xun
authors.initials: X
authors.lastname: Ye
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China; Department of Neurosurgery, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurosurgery, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Xingju
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China; Department of Neurosurgery, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurosurgery, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Deng
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China; Department of Neurosurgery, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurosurgery, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China; Department of Neurosurgery, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurosurgery, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China; Department of Neurosurgery, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurosurgery, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing, China; Department of Neurosurgery, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurosurgery, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China. Electronic address: zhaojz205@yahoo.com.
authors.forename: Jizong
authors.initials: J
authors.lastname: Zhao
mesh_terms: D000367:Age Factors; D000368:Aged; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cerebral revascularization; Clinical features; Elderly moyamoya disease; Outcome