Comparison of the Complications Arising After Superficial Temporal Artery-Middle Cerebral Artery Anastomosis in Adult Moyamoya Disease and Atherosclerotic Disease

Kim, Yong Chan; Kim, Seung Hyun; Bang, Jae Seung; Hwang, Gyojun; Kwon, O Ki; Oh, Chang Wan

Abstract

OBJECTIVE
To assess the results of superficial temporal artery-middle cerebral artery anastomosis (SMA) in atherosclerotic disease (ASD) and in adult moyamoya disease (MMD) by comparing the complications that arise.
METHODS
We retrospectively reviewed patients with ASD or adult MMD treated by means of SMA, between December 2004 and December 2006, at our neurovascular center. During this period, we performed 115 SMAs on 108 patients: 61 on ASD patients (61 SMAs; the ASD group) and 47 on adult MMD patients (54 SMAs; the MMD group).
RESULTS
We found a higher incidence of permanent neurological deficits (PNDs) and a lower incidence of transient neurological deficits (TNDs) in the MMD group than in the ASD group (p-value=0.047). Patients with a preoperative stroke (cerebral infarction/hemorrhage) history were more likely to develop postoperative PND than were the patients with a preoperative history of transient ischemic attack (TIA), in both the ASD (p-values=0.012 and 0.033, respectively) and MMD groups (p-values=0.000 and 0.015, respectively), regardless of overall patients (n=108) and single SMA group (n=62). Delayed seizure (seizure occurring > 1 month after SMA) occurred only in 8 MMD patients (8/47, 17.0%; p-value=0.003) out of all 108 patients and in 2 patients (2/10, 20%, p-value=0.014) out of the single SMA group.
CONCLUSION
Regardless of whether the diagnosis is ASD or MMD, patients with TIA preoperatively seem more prone to develop postoperative TND, and patients with a stroke history seem more prone to develop PND in both ASD and MMD groups. However, MMD patients appear more likely to experience a delayed seizure attack after SMA than ASD patients are.