Bony carotid canal hypoplasia in patients with moyamoya disease

Clinical article

Arata Watanabe M.D., Ph.D. 1 , 2 , Tomohiro Omata M.D., Ph.D. 2 , Hidehito Koizumi M.D., Ph.D. 3 , Shin Nakano M.D., Ph.D. 3 , Nobuyasu Takeuchi M.D. 3 and Hiroyuki Kinouchi M.D., Ph.D. 1
View More View Less
  • 1 Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo;
  • 2 Department of Neurosurgery, Tsuru Municipal Hospital, Tsuru; and
  • 3 Department of Neurosurgery, Yamanashi Prefectural Hospital, Yamanashi, Japan
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

The natural history of moyamoya disease is not well known. We have observed that the bony carotid canal is hypoplastic in patients with adult onset moyamoya disease. Bony carotid canal development should represent internal carotid artery (ICA) development, and may stop with the beginning of ICA stenosis. The purpose of this study was to determine the onset of moyamoya disease by measuring the bony carotid canal.

Methods

The normal diameter of the bony carotid canal was evaluated on 4-mm thick bone window CT scans of the skull base in 60 Japanese patients aged 20–80 years, who had minor head trauma or headache considered to be unrelated to the skull base or arterial systems. The relationship between age and bony carotid canal development was assessed in a second group of 50 patients aged 0–19 years, including 10 under 2 years, using CT scans with the same parameters. The diameter of the bony carotid canal in 17 Japanese patients with moyamoya disease was measured.

Results

The normal diameter in adults was 5.27 ± 0.62 mm (mean ± SD). The bony carotid canal developed rapidly before approximately 2 years of age. After fusion of the bony suture, the bony carotid canal developed slowly. The mean diameter of the bony carotid canal was 3.31 ± 0.44 mm in 11 adult patients with adult-onset moyamoya disease. According to the apparent curve of bony carotid canal development, ICA stenosis was assumed to start in early childhood.

Conclusions

Our findings suggest that most cases of Asian moyamoya disease may arise in childhood and that many Asian adult patients with moyamoya disease may develop occlusive vasculopathy in childhood.

Abbreviation used in this paper: ICA = internal carotid artery.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Arata Watanabe, M.D., Ph.D., Department of Neurosurgery, Tsuru Municipal Hospital, 5-1-55, Tsuru, Tsuru City, Yamanashi 402-0056, Japan. email to: arata@yamanashi.ac.jp.
  • 1

    Cali RL, , Berg R, & Rama K: Bilateral internal carotid artery agenesis: a case study and review of the literature. Surgery 113:227233, 1993

    • Search Google Scholar
    • Export Citation
  • 2

    Hallemeier CL, , Rich KM, , Grubb RL Jr, , Chicoine MR, , Moran CJ, & Cross DT III, : Clinical features and outcome in North American adults with moyamoya phenomenon. Stroke 37:14901496, 2006

    • Search Google Scholar
    • Export Citation
  • 3

    Handa J, , Matsuda I, , Nakasu S, & Nakano Y: Agenesis of an internal carotid artery: angiographic, tomographic and computed tomographic correlation. Neuroradiology 19:207211, 1980

    • Search Google Scholar
    • Export Citation
  • 4

    Houkin K, , Kamiyama H, , Abe H, , Takahashi A, & Kuroda S: Surgical therapy for adult moyamoya disease. Can surgical revascularization prevent the recurrence of intracerebral hemorrhage?. Stroke 27:13421346, 1996

    • Search Google Scholar
    • Export Citation
  • 5

    Karasawa J, , Touho H, , Ohnishi H, , Miyamoto S, & Kikuchi H: Long-term follow-up study after extracranial-intracranial bypass surgery for anterior circulation ischemia in childhood moyamoya disease. J Neurosurg 77:8489, 1992

    • Search Google Scholar
    • Export Citation
  • 6

    Kuriyama S, , Kusaka Y, , Fujimura M, , Wakai K, , Tamakoshi A, & Hashimoto S, : Prevalence and clinicoepidemiological features of moyamoya disease in Japan: findings from a nationwide epidemiological survey. Stroke 39:4247, 2008

    • Search Google Scholar
    • Export Citation
  • 7

    Kuroda S, & Houkin K: Moyamoya disease: current concepts and future perspectives. Lancet Neurol 7:10561066, 2008

  • 8

    Kuroda S, , Houkin K, , Ishikawa T, , Nakayama N, , Ikeda J, & Ishii N, : Determinants of intellectual outcome after surgical revascularization in pediatric moyamoya disease: a multivariate analysis. Childs Nerv Syst 20:302308, 2004

    • Search Google Scholar
    • Export Citation
  • 9

    Lee JH, , Oh CW, , Lee SH, & Han DH: Aplasia of the internal carotid artery. Acta Neurochir (Wien) 145:117125, 2003

  • 10

    Quint DJ, , Silbergleit R, & Young WC: Absence of the carotid canals at skull base CT. Radiology 182:477481, 1992

  • 11

    Scott RM, & Smith ER: Moyamoya disease and moyamoya syndrome. N Engl J Med 360:12261237, 2009

  • 12

    Suzuki J, & Kodama N: Moyamoya disease—a review. Stroke 14:104109, 1983

  • 13

    Suzuki J, & Takaku A: Cerebrovascular “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 20:288299, 1969

    • Search Google Scholar
    • Export Citation
  • 14

    Yamauchi T, , Tada M, , Houkin K, , Tanaka T, , Nakamura Y, & Kuroda S, : Linkage of familial moyamoya disease (spontaneous occlusion of the circle of Willis) to chromosome 17q25. Stroke 31:930935, 2000

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 326 155 13
Full Text Views 49 13 0
PDF Downloads 156 8 0
EPUB Downloads 0 0 0