Search Results

You are looking at 1 - 10 of 92 items for :

  • "indirect bypass" x
Clear All
Restricted access

Xiaofeng Deng, Faliang Gao, Dong Zhang, Yan Zhang, Rong Wang, Shuo Wang, Yong Cao, Yuanli Zhao, Yuesong Pan, Xingju Liu, Qian Zhang and Jizong Zhao

MMD can lead to ischemic or hemorrhagic strokes such as transient ischemia attack (TIA), cerebral infarction, and intraventricular hemorrhage. Depending on the manifestation, MMD is usually classified into 2 main phenotypes: ischemic or hemorrhagic. 14 , 32 The ideal treatment of MMD should be effective in both improving symptoms and preventing recurrent strokes. In recent decades, bypass surgical procedures have been developed and are the most popular treatment strategy nowadays. The most commonly used surgical modalities include indirect bypass (IB), direct bypass

Full access

Robert M. Starke, Ricardo J. Komotar and E. Sander Connolly

moyamoya disease for > 30 years. 11 , 13 , 22 , 25 , 26 Many case series have demonstrated a decrease in ischemic symptoms and/or the maintenance of cognitive abilities in patients treated with direct bypass, but these series have been composed chiefly of children and often have included patients treated with indirect bypass or a combination of direct and indirect bypasses. 4 , 11 , 13 , 25 , 34 , 37 , 43 Thus far, no study has documented overall long-term rates of ischemic events in adult patients treated solely with direct bypass. Indirect Bypass for Moyamoya

Full access

Maki Mukawa, Tadashi Nariai, Motoki Inaji, Natsumi Tamada, Taketoshi Maehara, Yoshiharu Matsushima, Kikuo Ohno, Mariko Negi and Daisuke Kobayashi

A technique for indirect bypass surgery was developed as a unique treatment strategy for juvenile patients with moyamoya disease (MMD). 9 , 12 In this technique, a newly formed vascular network connects the external and internal carotid systems spontaneously without direct mechanical vessel-to-vessel sutures. Many recent studies have suggested that indirect bypass surgery is useful for MMD in adults as well as juveniles. 1 , 2 , 21 The efficacy of the procedure for adult atherosclerotic intracranial occlusive disease has also been documented by an

Restricted access

Makoto Goda, Mitsuo Isono, Keisuke Ishii, Tohru Kamida, Tatsuya Abe and Hidenori Kobayashi

(c), right ECA (d), and left VA (e). In this case, PCA—MCA leptomeningeal collateral formations were not prominent before surgery and there were no obvious changes in these formations 12 years after surgery. On the other hand, abnormal collateral formations from the PChAs and the pericallosal artery markedly decreased. Discussion Although the number of cases was limited in this study, indirect bypass surgery failed to reduce the abnormal collateral formations from the posterior circulation, especially those involving midline structures, during long

Full access

Mario K. Teo, Venkatesh S. Madhugiri and Gary K. Steinberg

Direct anastomoses are also associated with excellent clinical outcomes, including a higher rate of symptomatic improvement, lower risk of recurrent ischemia, and increased stroke-free survival compared with indirect bypass. 1 , 11 , 12 In their comparative analysis of adult patients, the authors included 6 adult series (one of which was our Stanford series), in which 762 cases had direct bypasses and 1524 had indirect bypasses. The perioperative risks of death, ischemic stroke, and intracranial hemorrhage were very similar between the two groups. However, the long

Restricted access

Rimal H. Dossani and Hai Sun

TO THE EDITOR: We read with interest the article by Deng et al. 2 ( Deng X, Gao F, Zhang D, et al: Direct versus indirect bypasses for adult ischemic-type moyamoya disease: a propensity score–matched analysis. J Neurosurg [epub ahead of print August 11, 2017. DOI: 10.3171/2017.2.JNS162405 ]) demonstrating that direct bypass (DB) is better than indirect bypass (IB) in preventing recurrent ischemic strokes in adults with ischemic-type moyamoya disease. A common shortcoming of some studies on moyamoya disease is the heterogeneity of the patient population (adult

Full access

Huai-Yu Tong, Yuan-Zheng Zhang, Sheng Li and Xin-Guang Yu

clinically soon (several hours or days) after the operation, despite the fact that the STA did not immediately develop anastomosis. The mechanism should be further researched. Komotar et al. 9 concluded that indirect bypass does not promote adequate pial collateral artery development and appears to be of limited utility in patients with symptomatic internal carotid artery (ICA) or MCA stenoocclusive disease and secondary hemodynamic failure. Dusick et al. thought that Komotar's patients represented a different group from their own because Komotar's cohort presented with

Restricted access

Haruto Uchino, Daina Kashiwazaki, Naoki Akioka, Masaki Koh, Naoya Kuwayama, Kiyohiro Houkin and Satoshi Kuroda

surgery. 2 Indirect bypass procedures include various methods such as encephalo-duro-arterio-synangiosis (EDAS), 23 encephalo-myo-synangiosis (EMS), 12 and multiple burr hole surgery. 13 Although the initial surgeries are effective in most cases, repeat bypass surgeries, defined as additional surgeries in the ipsilateral hemisphere of the initial surgery, could be required in a subset of cases. 7 , 9 , 15 , 22 , 24 , 29 , 35 , 36 Indirect bypass through a limited craniotomy is sometimes insufficient and could result in recurrence of transient ischemic attacks (TIAs

Restricted access

Yahui Zhao, Jiaxi Li, Junlin Lu, Qian Zhang, Dong Zhang, Rong Wang, Yuanli Zhao and Xiaolin Chen

I ndirect revascularization, or indirect bypass surgery, is an essential component of surgical treatment for moyamoya disease (MMD). This procedure improves cerebral perfusion by attaching pedicled, vascularized grafts to cortical surface and facilitating ingrowth of neoangiogenesis. 1 , 2 , 10 , 20 Thus far, a variety of indirect revascularization methods had been developed, including encephaloduroarteriosynangiosis (EDAS), encephalodurogaleo(periosteal) synangiosis (EDGS), and multiple burr hole (MBH) surgery. 11 , 12 , 18 Compared to direct

Restricted access

Robert M. Starke, Ricardo J. Komotar, Zachary L. Hickman, Yehuda E. Paz, Angela G. Pugliese, Marc L. Otten, Matthew C. Garrett, Mitchell S. V. Elkind, Randolph S. Marshall, Joanne R. Festa, Philip M. Meyers and E. Sander Connolly Jr.

surgery has been used successfully to augment collateral blood flow in patients with moyamoya disease for over 30 years. 10 , 12 , 14 , 18 , 19 Direct STA-MCA bypass, however, can be difficult in children because of both the size and progressive occlusion of the MCAs. In contrast, encephaloduroarteriosynangiosis (EDAS) is a method of indirect bypass and cerebral revascularization that has been shown to be beneficial in this patient population. 3 , 8 , 10 , 16 , 19 This operative technique is also considered easier, safer in patients with serious medical comorbidities