Treatment of moyamoya disease with STA-MCA anastomosis

Restricted access

✓ Moyamoya disease is a chronic occlusive cerebrovascular disease of unknown etiology for which no effective treatment has been found. The authors report the results of 23 superficial temporal-middle cerebral artery (STA-MCA) anastomoses and seven encephalomyosynangioses, performed on 13 cases with moyamoya disease and on four additional atypical cases. There were 10 children and seven adults in this study. The follow-up period ranged from 1 year and 4 months to 4 years and 1 month postoperatively; nine patients had excellent results, five good, and one fair; two patients were unchanged. The anastomotic procedure was most effective for transient ischemic attacks, reversible ischemic neurological deficits, and even minor or moderate neurological symptoms. The STA-MCA anastomosis appears to be an effective treatment for moyamoya disease.

Article Information

Address reprint requests to: Jun Karasawa, M.D., Department of Neurosurgery, National Cardio-Vascular Center, Research Institute, Fujishiro-dai, Suita, Osaka 565, Japan.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Case 3. Upper Left: Left internal carotid artery (ICA) angiogram showing occlusion of the ICA in its supraclinoid portion, abnormal vascular networks (basal moyamoya) as collaterals in the region of the basal ganglia, and normograde filling of the proximal part of the anterior cerebral artery (ACA) and some branches of the middle cerebral artery (MCA) through basal moyamoya. Leptomeningeal collaterals arising from the posterior cerebral artery (PCA) fill the other branches of the MCA in retrograde fashion. Upper Right: Right ICA angiogram, showing narrowing of the ICA at the supraclinoid portion and filling of some branches of the ACA and MCA and basal moyamoya. Other branches of the MCA and ACA are filled in retrograde fashion through the enlarged PCA. Lower Left: Superselective left superficial temporal artery (STA) angiogram, 5 months after the operation. Arrows indicate the points of anastomosis. The STA is shown feeding the anterior parietal and prefrontal arteries. Fine vessels (cortical moyamoya) arising from these branches of the MCA and the stem of the STA supply the other branches of the MCA. Lower Right: Right external carotid angiogram, 8 days after the operation, showing the anterior parietal artery via the STA. The patent end-to-side anastomosis is demonstrated (arrow). Other branches of the MCA are not visualized since the anterior parietal artery is occluded at its proximal part.

  • View in gallery

    Case 13. Upper Left: Left internal carotid artery (ICA) angiogram, demonstrating narrowing of the ICA at the suprachnoid portion, and filling of the bilateral anterior cerebral arteries (ACA's) through the left horizontal part of the ACA. The middle cerebral artery (MCA) is supplied through a basal moyamoya. Upper Right: Right ICA angiogram, showing occlusion of the ICA in its supraclinoid portion. The MCA is demonstrated via the basal moyamoya, and the ACA via the dorsal callosal artery in retrograde fashion. Lower Left: Superselective left superficial temporal angiogram, 2 months after the operation, showing patent triple anastomoses (arrows). Lower Right: Right external carotid angiogram 2 weeks after the operation, showing the anastomoses (arrow).

References

  • 1.

    Handa JNakano YOkuno Tet al: Computerized tomography in moyamoya syndrome. Surg Neurol 7:3153191977Handa J Nakano Y Okuno T et al: Computerized tomography in moyamoya syndrome. Surg Neurol 7:315–319 1977

  • 2.

    Henschen C: Operative Revascularization des zirkulatorisch geschädigten Gehirns durch Anlegen gestielter Muskellappen. (Encephalomyo-synangiose). Langenbecks Arch Klin Chir 264:3924011950Henschen C: Operative Revascularization des zirkulatorisch geschädigten Gehirns durch Anlegen gestielter Muskellappen. (Encephalomyo-synangiose). Langenbecks Arch Klin Chir 264:392–401 1950

  • 3.

    Maki YNakada YNose Tet al: Clinical and radioisotopic follow-up study of ‘moyamoya.’ Childs Brain 2:2572711976Maki Y Nakada Y Nose T et al: Clinical and radioisotopic follow-up study of ‘moyamoya.’ Childs Brain 2:257–271 1976

  • 4.

    Nishimoto A: [Abnormal cerebrovascular network related to internal carotid arteries. Diagnosis and treatment.] Igakukaisokaishi 18:126912721971 (Jpn)Nishimoto A: [Abnormal cerebrovascular network related to internal carotid arteries. Diagnosis and treatment.] Igakukaisokaishi 18:1269–1272 1971 (Jpn)

  • 5.

    Reichman OHAnderson RERoberts TSet al: The treatment of intracranial occlusive cerebrovascular disease by STA-cortical MCA anastomosis in Handa H (ed): Microneurosurgery. Tokyo: Igaku Shoin1975 pp 3146Reichman OH Anderson RE Roberts TS et al: The treatment of intracranial occlusive cerebrovascular disease by STA-cortical MCA anastomosis in Handa H (ed): Microneurosurgery. Tokyo: Igaku Shoin 1975 pp 31–46

  • 6.

    Salamon GGonzalés JRaybaud Cet al: Analyse angiographique des branches corticales de l'artère sylvienne. Neurochirurgie 17:1771891971Salamon G Gonzalés J Raybaud C et al: Analyse angiographique des branches corticales de l'artère sylvienne. Neurochirurgie 17:177–189 1971

  • 7.

    Suzuki JTakaku AKodama Net al: An attempt to treat cerebrovascular “moyamoya” disease in children. Childs Brain 1:1932061975Suzuki J Takaku A Kodama N et al: An attempt to treat cerebrovascular “moyamoya” disease in children. Childs Brain 1:193–206 1975

  • 8.

    Yaşargil MG: Microsurgery Applied to Neurosurgery. Stuttgart: Georg Thieme Verlag1969 pp 105115Yaşargil MG: Microsurgery Applied to Neurosurgery. Stuttgart: Georg Thieme Verlag 1969 pp 105–115

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 152 152 25
Full Text Views 183 183 1
PDF Downloads 75 75 1
EPUB Downloads 0 0 0

PubMed

Google Scholar