Cerebral circulation and oxygen metabolism in childhood moyamoya disease: a perioperative positron emission tomography study

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  • 1 Departments of Neurosurgery and Radiology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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✓ Thirteen children with moyamoya disease who had no apparent cerebral infarction or hemorrhage were examined pre- and postoperatively by means of positron emission tomography (PET) to investigate the underlying cerebral circulation and metabolism and the effect of bypass surgery. The preoperative regional cerebral blood flow (rCBF) and mean transit time were significantly decreased and increased, respectively, in the cerebral cortex of these patients compared to control values. The regional cerebral blood volume (rCBV) and the regional oxygen extraction fraction (rOEF) had significantly increased to compensate for the reduced rCBF and perfusion pressure and also to maintain the regional cerebral metabolic rate of oxygen (rCMRO2). In the basal ganglia, rCBV elevation was more prominent than that in the cerebral cortex, although changes in rCBF, rOEF, and rCMRO2 were relatively minor.

Postoperative improvements were observed predominantly near the cortex where bypass surgery had been performed and in the basal ganglia. Direct and combined indirect bypass procedures improved cerebral circulation more effectively than single indirect bypass surgery. Although the angiographic findings were not always compatible with the clinical results, the postoperative improvements on PET scans correlated with the disappearance of transient ischemic attacks. In addition to the clinical courses and angiographic findings, PET analysis was indispensable in evaluating the cerebral circulation and metabolism in childhood moyamoya disease.

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Contributor Notes

Address reprint requests to: Kiyonobu Ikezaki, M.D., Department of Neurosurgery, Neurological Institute, Faculty of Medicine, Kyushu University, Fukuoka 812, Japan.
  • 1.

    Abe H, , Kamiyama H, & Kuroda S, et al: Cerebral blood flow in the children with spontaneous occlusion of the circle of Willis: Comparison with that of healthy children, in Yonekawa Y (ed): The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1991. National Cardiovascular Center: Osaka, Japan, 1992, pp 2125 Abe H, Kamiyama H, Kuroda S, et al: Cerebral blood flow in the children with spontaneous occlusion of the circle of Willis: Comparison with that of healthy children, in Yonekawa Y (ed): The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1991. National Cardiovascular Center: Osaka, Japan, 1992, pp 21–25

    • Search Google Scholar
    • Export Citation
  • 2.

    Baron JC, , Bousser MG, & Rey A, et al: Reversal of focal “misery-perfusion syndrome” by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. A case study with 15O positron emission tomography. Stroke 12:454459, 1981 Baron JC, Bousser MG, Rey A, et al: Reversal of focal “misery-perfusion syndrome” by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. A case study with 15O positron emission tomography. Stroke 12:454–459, 1981

    • Search Google Scholar
    • Export Citation
  • 3.

    Cahan LD: Failure of encephalo-duro-arterio-synangiosis procedure in moyamoya disease. Pediatr Neurosci 12:5862, 1985–1986 Cahan LD: Failure of encephalo-duro-arterio-synangiosis procedure in moyamoya disease. Pediatr Neurosci 12:58–62, 1985–1986

    • Search Google Scholar
    • Export Citation
  • 4.

    The EC/IC Bypass Study Group: Failure of extracranialintracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 313:11911200, 1985 The EC/IC Bypass Study Group: Failure of extracranialintracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 313:1191–1200, 1985

    • Search Google Scholar
    • Export Citation
  • 5.

    Frackowiack RSJ, , Lenzi GL, & Jones T, et al: Quantitative measurement of regional cerebral blood flow and oxygen metabolism in man using 15O and positron emission tomography: theory, procedure and normal values. J Comput Assist Tomogr 4:727736, 1980 Frackowiack RSJ, Lenzi GL, Jones T, et al: Quantitative measurement of regional cerebral blood flow and oxygen metabolism in man using 15O and positron emission tomography: theory, procedure and normal values.J Comput Assist Tomogr 4:727–736, 1980

    • Search Google Scholar
    • Export Citation
  • 6.

    Fukui M, , Ikezaki K, & Matsushima T, et al: Endothelin, elastase-like activity, elastase inhibitory capacity in the sera of patients with moyamoya disease, in Yonekawa Y (ed): The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1991. National Cardiovascular Center: Osaka, Japan, 1992, pp 7277 Fukui M, Ikezaki K, Matsushima T, et al: Endothelin, elastase-like activity, elastase inhibitory capacity in the sera of patients with moyamoya disease, in Yonekawa Y (ed): The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1991. National Cardiovascular Center: Osaka, Japan, 1992, pp 72–77

    • Search Google Scholar
    • Export Citation
  • 7.

    Fukui M, , Matsushima T, & Fujii K, et al: Differences in cerebral hemodynamics and metabolism between pediatric and adult patients with moyamoya disease: a study using positron emission tomography, in Handa H (ed): The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1987. Hamamatsu Rosai Hospital: Hamamatsu, Japan, 1988, pp 7680 Fukui M, Matsushima T, Fujii K, et al: Differences in cerebral hemodynamics and metabolism between pediatric and adult patients with moyamoya disease: a study using positron emission tomography, in Handa H (ed): The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1987. Hamamatsu Rosai Hospital: Hamamatsu, Japan, 1988, pp 76–80

    • Search Google Scholar
    • Export Citation
  • 8.

    Fukui M, , Matsushima T, & Kuwabara Y, et al: Hemodynamic evaluation of moyamoya disease in children with positron emission computed tomography before and after neurosurgical procedures (EDAS, EMS, EMAS), in Handa H (ed): The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1986. Hamamatsu Rosai Hospital: Hamamatsu, Japan, 1987, pp 9198 Fukui M, Matsushima T, Kuwabara Y, et al: Hemodynamic evaluation of moyamoya disease in children with positron emission computed tomography before and after neurosurgical procedures (EDAS, EMS, EMAS), in Handa H (ed): The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1986. Hamamatsu Rosai Hospital: Hamamatsu, Japan, 1987, pp 91–98

    • Search Google Scholar
    • Export Citation
  • 9.

    Gibbs JM, , Wise RJ, & Leenders KL, et al: Evaluation of cerebral perfusion reserve in patients with carotid-artery occlusion. Lancet 1:310314, 1984 Gibbs JM, Wise RJ, Leenders KL, et al: Evaluation of cerebral perfusion reserve in patients with carotid-artery occlusion. Lancet 1:310–314, 1984

    • Search Google Scholar
    • Export Citation
  • 10.

    Goto F, , Ebihara S, & Hata T: Local cerebral blood flow and CO2 responsiveness in patients with “moyamoya disease,” in Meyer JS, , Lechner H, & Reivich M (eds): Cerebral Vascular Disease 6. Amsterdam: Excerpta Medica, 1987, pp 9196 Goto F, Ebihara S, Hata T: Local cerebral blood flow and CO2 responsiveness in patients with “moyamoya disease,” in Meyer JS, Lechner H, Reivich M (eds): Cerebral Vascular Disease 6. Amsterdam: Excerpta Medica, 1987, pp 91–96

    • Search Google Scholar
    • Export Citation
  • 11.

    Goto Y, & Yonekawa Y: Worldwide distribution of moyamoya disease. Neurol Med Chir 32:883886, 1992 Goto Y, Yonekawa Y: Worldwide distribution of moyamoya disease. Neurol Med Chir 32:883–886, 1992

    • Search Google Scholar
    • Export Citation
  • 12.

    Gotoh F: Guideline to the diagnosis of occlusion of the circle of Willis, in Gotoh F (ed:) The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1978. Keio University: Tokyo, Japan, 1979, p 132 Gotoh F: Guideline to the diagnosis of occlusion of the circle of Willis, in Gotoh F (ed:) The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1978. Keio University: Tokyo, Japan, 1979, p 132

    • Search Google Scholar
    • Export Citation
  • 13.

    Inoue T, , Matsushima T, & Nagata S, et al: Frontal encephalo-myo-arterio-synangiosis (EMAS). Cereb Stroke 20:297300, 1992 Inoue T, Matsushima T, Nagata S, et al: Frontal encephalo-myo-arterio-synangiosis (EMAS). Cereb Stroke 20:297–300, 1992

    • Search Google Scholar
    • Export Citation
  • 14.

    Karasawa J, , Kikuchi H, & Furuse S, et al: A surgical treatment of “moyamoya” disease: “Encephalo-myo-synangiosis.” Neurol Med Chir 17 (Part 1):2937, 1977 Karasawa J, Kikuchi H, Furuse S, et al: A surgical treatment of “moyamoya” disease: “Encephalo-myo-synangiosis.” Neurol Med Chir 17 (Part 1):29–37, 1977

    • Search Google Scholar
    • Export Citation
  • 15.

    Karasawa J, , Kikuchi H, & Furuse S, et al: Treatment of moyamoya disease with STA-MCA anastomosis. J Neurosurg 49:679688, 1978 Karasawa J, Kikuchi H, Furuse S, et al: Treatment of moyamoya disease with STA-MCA anastomosis. J Neurosurg 49:679–688, 1978

    • Search Google Scholar
    • Export Citation
  • 16.

    Karasawa J, , Touho H, & Ohnishi H, et al: Long-term follow-up study after extracranial -intracranial bypass surgery for anterior circulation ischemia in childhood moyamoya disease. J Neurosurg 77:8489, 1992 Karasawa J, Touho H, Ohnishi H, et al: Long-term follow-up study after extracranial -intracranial bypass surgery for anterior circulation ischemia in childhood moyamoya disease. J Neurosurg 77:84–89, 1992

    • Search Google Scholar
    • Export Citation
  • 17.

    Kitamura K, , Fukui M, & Oka K, et al: Moyamoya disease, in Toole JF (ed): Handbook of Clinical Neurology. Amsterdam: Elsevier, 1989, Vol 11, pp 293306 Kitamura K, Fukui M, Oka K, et al: Moyamoya disease, in Toole JF (ed): Handbook of Clinical Neurology. Amsterdam: Elsevier, 1989, Vol 11, pp 293–306

    • Search Google Scholar
    • Export Citation
  • 18.

    Kitamura K, , Matsushima T, & Kuwabara Y: Positron CT in children with moyamoya disease, in Handa H (ed): The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1985. Hamamatsu Rosai Hospital: Hamamatsu, Japan, 1986, pp 120128 Kitamura K, Matsushima T, Kuwabara Y: Positron CT in children with moyamoya disease, in Handa H (ed): The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1985. Hamamatsu Rosai Hospital: Hamamatsu, Japan, 1986, pp 120–128

    • Search Google Scholar
    • Export Citation
  • 19.

    Krayenbühl HA: The moyamoya syndrome and the neurosurgeon. Surg Neurol 4:353360, 1975 Krayenbühl HA: The moyamoya syndrome and the neurosurgeon. Surg Neurol 4:353–360, 1975

    • Search Google Scholar
    • Export Citation
  • 20.

    Kurokawa T, , Tomita S, & Ueda K, et al: Prognosis of occlusive disease of the circle of Willis (moyamoya disease) in children. Pediatr Neurol 1:274277, 1985 Kurokawa T, Tomita S, Ueda K, et al: Prognosis of occlusive disease of the circle of Willis (moyamoya disease) in children. Pediatr Neurol 1:274–277, 1985

    • Search Google Scholar
    • Export Citation
  • 21.

    Kuwabara Y: [Evaluation of regional cerebral circulation and metabolism in moyamoya disease using positron emission computed tomography.] Jpn J Nucl Med 23:13811402, 1986 (Jpn) Kuwabara Y: [Evaluation of regional cerebral circulation and metabolism in moyamoya disease using positron emission computed tomography.] Jpn J Nucl Med 23:1381–1402, 1986 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 22.

    Kuwabara Y, , Ichiya Y, & Otsuka M, et al: Cerebral hemodynamic change in the child and the adult with moyamoya disease. Stroke 21:272277, 1990 Kuwabara Y, Ichiya Y, Otsuka M, et al: Cerebral hemodynamic change in the child and the adult with moyamoya disease. Stroke 21:272–277, 1990

    • Search Google Scholar
    • Export Citation
  • 23.

    Lammertsma AA, & Jones T: Correction for the presence of intravascular oxygen-15 in the steady state technique for measuring regional oxygen extraction ratio in the brain: 1. Description of the method. J Cereb Blood Flow Metab 3:416424, 1983 Lammertsma AA, Jones T: Correction for the presence of intravascular oxygen-15 in the steady state technique for measuring regional oxygen extraction ratio in the brain: 1. Description of the method. J Cereb Blood Flow Metab 3:416–424, 1983

    • Search Google Scholar
    • Export Citation
  • 24.

    Matsushima T, , Fujiwara S, & Nagata S, et al: Reoperation for moyamoya disease refractory to encephalo-duro-arteriosynangiosis. Acta Neurochir 107:129132, 1990 Matsushima T, Fujiwara S, Nagata S, et al: Reoperation for moyamoya disease refractory to encephalo-duro-arteriosynangiosis. Acta Neurochir 107:129–132, 1990

    • Search Google Scholar
    • Export Citation
  • 25.

    Matsushima T, , Fujiwara S, & Nagata S, et al: Surgical treatment for paediatric patients with moyamoya disease by indirect revascularization procedures (EDAS, EMS, EMAS). Acta Neurochir 98:135140, 1989 Matsushima T, Fujiwara S, Nagata S, et al: Surgical treatment for paediatric patients with moyamoya disease by indirect revascularization procedures (EDAS, EMS, EMAS). Acta Neurochir 98:135–140, 1989

    • Search Google Scholar
    • Export Citation
  • 26.

    Matsushima T, , Fukui M, & Fujii K, et al: Two pediatric cases with occlusions of the ipsilateral internal carotid and posterior cerebral arteries associated with moyamoya vessels: “unilateral” moyamoya disease. Surg Neurol 33:276280, 1990 Matsushima T, Fukui M, Fujii K, et al: Two pediatric cases with occlusions of the ipsilateral internal carotid and posterior cerebral arteries associated with moyamoya vessels: “unilateral” moyamoya disease. Surg Neurol 33:276–280, 1990

    • Search Google Scholar
    • Export Citation
  • 27.

    Matsushima T, , Fukui M, & Kitamura K, et al: Encephaloduro-arterio-synangiosis in children with moyamoya disease. Acta Neurochir 104:96102, 1990 Matsushima T, Fukui M, Kitamura K, et al: Encephaloduro-arterio-synangiosis in children with moyamoya disease. Acta Neurochir 104:96–102, 1990

    • Search Google Scholar
    • Export Citation
  • 28.

    Matsushima T, , Inoue T, & Suzuki SO, et al: Surgical treatment of moyamoya disease in pediatric patients—comparison between the results of indirect and direct revascularization procedures. Neurosurgery 31:401405, 1992 Matsushima T, Inoue T, Suzuki SO, et al: Surgical treatment of moyamoya disease in pediatric patients—comparison between the results of indirect and direct revascularization procedures. Neurosurgery 31:401–405, 1992

    • Search Google Scholar
    • Export Citation
  • 29.

    Matsushima Y, , Aoyagi M, & Koumo Y, et al: Effects of encephalo-duro-arterio-synangiosis on childhood moyamoya patients—swift disappearance of ischemic attacks and maintenance of mental capacity. Neurol Med Chir 31:708714, 1991 Matsushima Y, Aoyagi M, Koumo Y, et al: Effects of encephalo-duro-arterio-synangiosis on childhood moyamoya patients—swift disappearance of ischemic attacks and maintenance of mental capacity. Neurol Med Chir 31:708–714, 1991

    • Search Google Scholar
    • Export Citation
  • 30.

    Miyamoto S, , Kikuchi H, & Karasawa J, et al: Pitfalls in the surgical treatment of moyamoya disease: operative techniques for refractory cases. J Neurosurg 68:537543, 1988 Miyamoto S, Kikuchi H, Karasawa J, et al: Pitfalls in the surgical treatment of moyamoya disease: operative techniques for refractory cases. J Neurosurg 68:537–543, 1988

    • Search Google Scholar
    • Export Citation
  • 31.

    Nishimoto A, & Takeuchi S: Abnormal cerebrovascular network related to the internal carotid arteries. J Neurosurg 29:255260, 1968 Nishimoto A, Takeuchi S: Abnormal cerebrovascular network related to the internal carotid arteries. J Neurosurg 29:255–260, 1968

    • Search Google Scholar
    • Export Citation
  • 32.

    Olds MV, , Griebel RW, & Hoffman HJ, et al: The surgical treatment of childhood moyamoya disease. J Neurosurg 66:675680, 1987 Olds MV, Griebel RW, Hoffman HJ, et al: The surgical treatment of childhood moyamoya disease. J Neurosurg 66:675–680, 1987

    • Search Google Scholar
    • Export Citation
  • 33.

    Pantano P, , Baron JC, & Lebrun Grandié P, et al: Regional cerebral blood flow and oxygen consumption in human aging. Stroke 15:635641, 1984 Pantano P, Baron JC, Lebrun Grandié P, et al: Regional cerebral blood flow and oxygen consumption in human aging. Stroke 15:635–641, 1984

    • Search Google Scholar
    • Export Citation
  • 34.

    Powers WJ, , Martin WRW, & Herscovitch P, et al: Extracranial-intracranial bypass surgery: hemodynamic and metabolic effects. Neurology 34:11681174, 1984 Powers WJ, Martin WRW, Herscovitch P, et al: Extracranial-intracranial bypass surgery: hemodynamic and metabolic effects. Neurology 34:1168–1174, 1984

    • Search Google Scholar
    • Export Citation
  • 35.

    Suzuki J, & Takaku A: Cerebrovascular “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 20:288299, 1969 Suzuki J, Takaku A: Cerebrovascular “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 20:288–299, 1969

    • Search Google Scholar
    • Export Citation
  • 36.

    Suzuki SO, , Matsushima T, & Ikezaki K, et al: Surgical treatment for adult patients with moyamoya disease—with special reference to hemorrhagic type. Surg Cereb Stroke 20:463467, 1992 Suzuki SO, Matsushima T, Ikezaki K, et al: Surgical treatment for adult patients with moyamoya disease—with special reference to hemorrhagic type. Surg Cereb Stroke 20:463–467, 1992

    • Search Google Scholar
    • Export Citation
  • 37.

    Tagawa T, , Naritomi H, & Mimaki T, et al: Regional cerebral blood flow, clinical manifestations, and age in children with moyamoya disease. Stroke 18:906910, 1987 Tagawa T, Naritomi H, Mimaki T, et al: Regional cerebral blood flow, clinical manifestations, and age in children with moyamoya disease. Stroke 18:906–910, 1987

    • Search Google Scholar
    • Export Citation
  • 38.

    Takeuchi K, & Shimizu K: [Hypoplasia of the bilateral internal carotid arteries.] Brain Nerve 9:3743, 1957 (Jpn) Takeuchi K, Shimizu K: [Hypoplasia of the bilateral internal carotid arteries.] Brain Nerve 9:37–43, 1957 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 39.

    Takeuchi S, , Tanaka R, & Ishii R, et al: Cerebral hemodynamics in patients with moyamoya disease. A study of regional cerebral blood flow by the 133Xe inhalation method. Surg Neurol 23:468474, 1985 Takeuchi S, Tanaka R, Ishii R, et al: Cerebral hemodynamics in patients with moyamoya disease. A study of regional cerebral blood flow by the 133Xe inhalation method. Surg Neurol 23:468–474, 1985

    • Search Google Scholar
    • Export Citation
  • 40.

    Takeuchi S, , Tsuchida T, & Kobayashi K, et al: Treatment of moyamoya disease by temporal muscle graft “encephalomyo-synangiosis.” Childs Brain 10:115, 1983 Takeuchi S, Tsuchida T, Kobayashi K, et al: Treatment of moyamoya disease by temporal muscle graft “encephalomyo-synangiosis.” Childs Brain 10:1–15, 1983

    • Search Google Scholar
    • Export Citation
  • 41.

    Taki W, , Yonekawa Y, & Kobayashi A, et al: Cerebral circulation and metabolism in adult's moyamoya disease—PET study. Acta Neurochir 100:150154, 1989 Taki W, Yonekawa Y, Kobayashi A, et al: Cerebral circulation and metabolism in adult's moyamoya disease—PET study. Acta Neurochir 100:150–154, 1989

    • Search Google Scholar
    • Export Citation
  • 42.

    Uemura K, , Yamaguchi K, & Kojima S, et al: Regional cerebral blood flow in cerebrovascular “moyamoya disease.” Study by 133Xe clearance method and cerebral angiography. Brain Nerve 27:385393, 1974 Uemura K, Yamaguchi K, Kojima S, et al: Regional cerebral blood flow in cerebrovascular “moyamoya disease.” Study by 133Xe clearance method and cerebral angiography. Brain Nerve 27:385–393, 1974

    • Search Google Scholar
    • Export Citation
  • 43.

    Usuki F, , Ohtani H, & Okadome T, et al: Immunocytochemical study on endothelial markers with cerebral vessel from a patient with familial moyamoya disease. Thromb Haemost 65:335338, 1991 Usuki F, Ohtani H, Okadome T, et al: Immunocytochemical study on endothelial markers with cerebral vessel from a patient with familial moyamoya disease. Thromb Haemost 65:335–338, 1991

    • Search Google Scholar
    • Export Citation
  • 44.

    Yamashita M, , Oka K, & Tanaka K: Cervico—cephalic arterial thrombi and thromboemboli in moyamoya disease—possible correlation with progressive intimal thickening in the intracranial major arteries. Stroke 15:264270, 1984 Yamashita M, Oka K, Tanaka K: Cervico—cephalic arterial thrombi and thromboemboli in moyamoya disease—possible correlation with progressive intimal thickening in the intracranial major arteries. Stroke 15:264–270, 1984

    • Search Google Scholar
    • Export Citation
  • 45.

    Yonekawa Y, , Handa H, & Okuno T: Moyamoya disease: diagnosis, treatment and recent achievement, in Barnett HJM (ed): Stroke. New York: Churchill Livingstone, 1986, Vol 2, pp 805829 Yonekawa Y, Handa H, Okuno T: Moyamoya disease: diagnosis, treatment and recent achievement, in Barnett HJM (ed): Stroke. New York: Churchill Livingstone, 1986, Vol 2, pp 805–829

    • Search Google Scholar
    • Export Citation
  • 46.

    Yonekawa Y, & Kawano T: Follow-up study of 632 cases in spontaneous occlusion of the circle of Willis registered from 1983 to 1991, in Yonekawa Y (ed): The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1991. National Cardiovascular Center: Osaka, Japan, 1992, pp 4147 Yonekawa Y, Kawano T: Follow-up study of 632 cases in spontaneous occlusion of the circle of Willis registered from 1983 to 1991, in Yonekawa Y (ed): The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1991. National Cardiovascular Center: Osaka, Japan, 1992, pp 41–47

    • Search Google Scholar
    • Export Citation
  • 47.

    Yonekawa Y, , Taki W, & Kobayashi A, et al: Cerebral circulation and metabolism of juvenile cases with “moyamoya” disease estimated by PET, in Handa H (ed): The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1986. Hamamatsu Rosai Hospital: Hamamatsu, Japan, 1987, pp 8890 Yonekawa Y, Taki W, Kobayashi A, et al: Cerebral circulation and metabolism of juvenile cases with “moyamoya” disease estimated by PET, in Handa H (ed): The Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Annual Report 1986. Hamamatsu Rosai Hospital: Hamamatsu, Japan, 1987, pp 88–90

    • Search Google Scholar
    • Export Citation

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