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.
FujimuraMMugikuraSKanetaTShimizuHTominagaT: Incidence and risk factors for symptomatic cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with moyamoya disease. Surg Neurol71:442–4472009
KaistiKKMetsähonkalaLTeräsMOikonenVAaltoSJääskeläinenS: Effects of surgical levels of propofol and sevoflurane anesthesia on cerebral blood flow in healthy subjects studied with positron emission tomography. Anesthesiology96:1358–13702002
KawamataTOkadaYKawashimaAYoneyamaTYamaguchiKOnoY: Postcarotid endarterectomy cerebral hyperperfusion can be prevented by minimizing intraoperative cerebral ischemia and strict postoperative blood pressure control under continuous sedation. Neurosurgery64:447–4542009
KawashimaAKawamataTYamaguchiKHoriTOkadaY: Successful superficial temporal artery-anterior cerebral artery direct bypass using a long graft for moyamoya disease: technical note. Neurosurgery67:3 Suppl Operativeons145–ons1492010
OkadaYShimaTNishidaMYamaneKYamadaTYamanakaC: Effectiveness of superficial temporal artery-middle cerebral artery anastomosis in adult moyamoya disease: cerebral hemodynamics and clinical course in ischemic and hemorrhagic varieties. Stroke29:625–6301998
YonekawaYHandaHMoritakeKTakiWYamagataSMiyakeH: Revascularization in children with moyamoya disease: low-density area and regional cerebral blood flow after operation. HandaHKikuchiHYonekawaY: Microsurgical Anastomosis for Cerebral IschemiaNew YorkIgaku-Shoin1985. 272–274