Short⁃term neurological function and clinical symptom improvement after cerebral revascularization in adults with moyamoya disease: a single⁃center study

Abstract

Objective In this study, short⁃term prognosis of cerebral revascularization was evaluated by comparative analysis of patients with moyamoya disease (MMD) with different disease types and different bypass. Methods A total of 44 patients with MMD treated in Beijing Tiantan Hospital Affiliated to Capital Medical University from January 2010 to October 2011 were enrolled. All patients underwent cerebral revascularization. The improvement of neurological function was evaluated by National Institutes of Health Stroke Scale (NIHSS) 3 months after surgery, and the improvement of clinical symptoms was observed. DSA or CTA were reviewed to determine whether the bridge vessels were unobstructed and surgical complications were recorded. Results DSA or CTA reexamination showed that the anastomosis was unobstructed, and no surgical complications occurred. Patients with MMD were divided into 3 groups according to the onset type: ischemic, hemorrhagic and mixed. Compared with hemorrhagic type and mixed type, neurological function improved 3 months after surgery in patients with ischemic type (χ2=3.853, P=0.001; χ2=4.110, P=0.001) and improvement of clinical symptoms (χ2=3.934, P=0.000; χ2=4.138, P=0.000) were better. According to the operation type, the patients were divided into 4 groups: anterior⁃frontal, anterior⁃temporal, posterior⁃frontal and posterior⁃temporal bypass. The improvement of neurological function in anterior⁃frontal bypass group was higher than that in anterior⁃temporal bypass group (χ2=2.079, P=0.038). The improvement of neurological function and clinincal symptooms in posterior⁃frontal bypass group were higher than those in anterior⁃temporal bypass group (χ2=2.909; P=0.004; χ2=2.812, P=0.005), and those in posterior⁃frontal bypass group were also higher than those in posterior⁃temporal bypass group (χ2=2.295, P=0.022; χ2=2.580, P=0.010). Conclusions Compared with the other 2 groups, symptoms of ischemic MMD may improved better than before, and the intraoperative selection of posterior⁃frontal and anterior⁃frontal bypass may be better than anterior⁃temporal and posterior⁃temporal bypass.

Keywords

• moyamoya disease
• cerebral revascularization
• temporal arteries
• middle cerebral artery
• prognosis