J Cerebrovasc Endovasc Neurosurg.  2016 Sep;18(3):239-246. 10.7461/jcen.2016.18.3.239.

The Efficacy of Single Barrel Superficial Temporal Artery-middle Cerebral Artery Bypass in Treatment of Adult Patients with Ischemic-type Moyamoya Disease

• Ha M
• Choi CH
• Lee JI
• Cha SH
• Lee SW
• Ko JK

• KMID: 2355648
• DOI: http://doi.org/10.7461/jcen.2016.18.3.239

Abstract

OBJECTIVE
So far, there is no study answering the question of which type of surgical technique is practically the most useful in the treatment of adult patients with ischemic type moyamoya disease (MMD). We evaluated the efficacy of single barrel superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in the treatment of adult patients with ischemic type MMD by retrospectively collecting clinical and radiological data.
MATERIALS AND METHODS
A retrospective review identified 31 adult patients who underwent 43 single barrel STA-MCA bypass procedures performed for treatment of ischemic-type MMD between 2006 and 2014. The male to female ratio was 17:14 and the mean age was 41 years (range, 21-65 years). Peri-operative complications, angiographic and clinical outcomes were analyzed retrospectively.
RESULTS
The permanent neurological morbidity and mortality rates were 2.3% and 0%, respectively. During the observation period of a mean of 35 months (range, 12-73 months), 29 patients (93.5%) had no further cerebrovascular events and transient ischemic attack occurred in two patients (6.5%), resulting in an annual stroke risk of 2.2%. Follow-up computed tomography perfusion (CTP) (mean, 18.4 months after surgery) documented improved cerebral hemodynamics in the revascularized hemispheres (p < 0.001). Post-operative patency was clearly verified in 38 bypasses (88.4%) of 43 bypasses on follow-up imaging (mean, 16.5 months).
CONCLUSION
Our results suggest that single barrel STA-MCA bypass with wide dural opening is safe and durable method of cerebral revascularization in adult patients with ischemic type MMD and can be considered as a potential treatment option for adult patients with ischemic type MMD.

Keyword

Adult; Moyamoya disease; Perfusion; Bypass surgery; Ischemia

MeSH Terms

Adult*
Cerebral Arteries*
Cerebral Revascularization
Female
Follow-Up Studies
Hemodynamics
Humans
Ischemia
Ischemic Attack, Transient
Male
Methods
Mortality
Moyamoya Disease*
Perfusion
Retrospective Studies
Stroke
Temporal Arteries

Figure

• 

  Fig. 1 A 48-year old, right-handed male presented with repeated right hemiparesis caused by known MMD. (A) Anteroposterior and lateral views of the left external carotid artery angiogram, obtained preoperatively, demonstrates no abnormal finding. (B) Anteroposterior and lateral views of the left external carotid artery angiogram 12 months after the operation shows that the STA (black arrow)-MCA anastomosis was in good patency and that extensive spontaneous anastomoses of the middle meningeal artery (white arrow) and the deep temporal artery (arrow head) formed with the cerebral cortical arteries. The deep temporal artery, middle meningeal artery, and the trunk of the STA became obviously thickened. (C) CTP scans with TTP and MTT obtained before and after the operation. Significant asymmetry between the right and left hemispheres with striking hypoperfusion of the left ICA territory shows substantial improvement after the operation. MMD = moyamoya disease; STA = superficial temporal artery; MCA = middle cerebral artery; CTP = computed tomography perfusion; TTP = time to peak; MTT = mean transit time.

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