The efficacy of superficial temporal artery–middle cerebral artery anastomosis in patients with moyamoya disease complaining of severe headache

Clinical article

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Some patients with moyamoya disease complain of severe headache, which may be closely related to cerebral ischemia. The efficacy of superficial temporal artery–middle cerebral artery (STA-MCA) anastomosis in these patients was evaluated by clinicoradiological studies.


Of 117 consecutive patients with ischemic moyamoya disease, 25 complained mainly of severe headache (headache group) and 92 had no significant headache (nonheadache group). Intensity of headache was evaluated pre- and postoperatively. Furthermore, regional cerebral blood flow (rCBF) and cerebrovascular reactivity (CVR) were assessed pre- and postoperatively.


The headache group was significantly younger than the nonheadache group. In a group corrected for the age distribution, preoperative rCBF and CVR were similar in headache and nonheadache groups. After STA-MCA anastomosis, 16 patients with headache experienced complete relief from headache, 7 patients showed remarkable improvements and discontinued medications for headache, and the remaining 2 patients had some alleviation of headache but sometimes required medication. In the headache group, the postoperative rCBF was significantly greater than the preoperative value. The postoperative rCBF in this group was also significantly greater than the postoperative rCBF in the nonheadache group.


These data suggest that severe headache is one of the main symptoms in young patients with moyamoya disease probably related to cerebral circulatory disturbances. An STA-MCA anastomosis is effective in relieving headache in patients with ischemic moyamoya disease manifesting severe headache, probably by improving perfusion pressure and cerebral circulation.

Abbreviations used in this paper: CAP = cortical arterial pressure; CBF = cerebral blood flow; CVR = cerebrovascular reactivity; ICA = internal carotid artery; MCA = middle cerebral artery; rCBF = regional CBF; STA = superficial temporal artery; TIA = transient ischemic attack.

Article Information

Address correspondence to: Yoshikazu Okada, M.D., Ph.D., Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo 162-8666, Japan, email:

Please include this information when citing this paper: published online December 9, 2011; DOI: 10.3171/2011.11.JNS11944.

© AANS, except where prohibited by US copyright law.



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    Upper: Age distributions (in years) of ischemic moyamoya disease patients with and without headache. Lower: Mean ages of normal control group and ischemic moyamoya disease patients with and without headache. Vertical bars in each column indicate SD. *p < 0.05; **p < 0.01.

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    Upper: Preoperative rCBF in the control, headache, and nonheadache groups. Lower: Preoperative CVR in normal control group, headache group, and nonheadache group. Vertical bars in each column indicate SD. **p < 0.01. NS = not significant.

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    Preoperative rCBF and CVR measured at the MCA territory on the operated side in patients with headache stratified by intensity of headache. Vertical bars indicate SD.

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    Comparison between preoperative and postoperative rCBF of the MCA territory at the operated side in the headache group. White columns indicate rCBF (postoperative value is corrected rCBF; see text for calculation). Gray columns indicate CBF ratio (rCBF of the operative side to rCBF of contralateral side). Vertical bars indicate SD. **p < 0.01.

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    Representative postoperative carotid angiograms from the headache group demonstrating the effect of STA-MCA anastomosis. Left: clear visualization of anastomosed MCA, bypass patency Class 1. Right: excellent visualization of almost the entire MCA territory, bypass patency Class 2.


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