Interdisciplinary Neurosurgery (Sep 2022)
Superficial temporal artery-middle cerebral artery bypass for moyamoya disease treatment in Vietnam: A single-center prospective study
Abstract
Objective: Moyamoya disease (MMD) is a rare progressive chronic cerebrovascular disease. There has been a lack of data on clinical characteristics and long-term outcomes in the treatment of MMD in Vietnam. Therefore, this study aims to investigate the clinical presentation of MMD in Vietnamese people as well as outcomes and complications during superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery. Methods: This single-center, prospective case series of MMD was conducted from January 2015 to December 2021 at the Department of Neurosurgery, University Medical Center at Ho Chi Minh City (UMC HCMC). Clinical characteristics, imaging, and modified Rankin Scale (mRS) of the patients were recorded preoperatively. We analyzed the surgical complications, postoperative mRS, patency of STA-MCA bypass, free TIA/stroke time after surgery, improvement of symptoms as well as quality of life at 6 months and 12 months after STA-MCA bypass surgery. Results: 39 patients with 55 bypass procedures (61.5% male, mean age 44.1 ± 13.9 years) were enrolled. At 3-month follow-up, all STA-MCA bypasses were patent. The surgical morbidity rate and mortality rate were noted at 3.6% and 0% per treated hemisphere, respectively. 94.87% of patients improved in their quality of life after surgery. Reduces in TIA symptom and headache were reported in 97% and 90% of cases, respectively. There was a statistically significant improvement in clinical status after 12 months of follow-up compared with that before surgery, as measured by mRS (0.97 ± 1.203 vs 2.33 ± 1.108). Good preoperative clinical condition (mRS ≤ 2) was noted as an important factor affecting the surgical outcomes. Conclusions: Revascularization surgery in patients with MMD is a safe and effective procedure. STA-MCA bypass surgery may improve the clinical status, reduce TIA/stroke event and improve the quality of life in MMD patients. Our findings suggest that it may be indicated for treatment of symptomatic MMD.
