Limits and pitfalls of indirect revascularization in moyamoya disease and syndrome
- PDF / 936,624 Bytes
- 11 Pages / 595.276 x 790.866 pts Page_size
- 13 Downloads / 193 Views
REVIEW
Limits and pitfalls of indirect revascularization in moyamoya disease and syndrome Pietro Fiaschi 1,2 & Marcello Scala 2,3 Armando Cama 3 & Marco Pavanello 3
&
Gianluca Piatelli 3 & Domenico Tortora 4
&
Francesca Secci 3 &
Received: 13 June 2020 / Revised: 11 August 2020 / Accepted: 15 September 2020 # The Author(s) 2020
Abstract Moyamoya vasculopathy is a rare chronic cerebrovascular disorder characterized by the stenosis of the terminal branches of the internal carotid arteries and the proximal tracts of anterior and middle cerebral arteries. Although surgical revascularization does not significantly change the underlying pathogenic mechanisms, it plays a pivotal role in the management of affected individuals, allowing to decrease the risk of ischemic and hemorrhagic complications. Surgical approaches may be direct (extracranialintracranial bypass), indirect, or a combination of the two. Several indirect techniques classifiable according to the tissue (muscle, periosteum, galea, dura mater, and extracranial tissues) or vessel (artery) used as a source of blood supply are currently available. In this study, we reviewed the pertinent literature and analyzed the advantages, disadvantages, and pitfalls of the most relevant indirect revascularization techniques. We discussed the technical aspects and the therapeutical implications of each procedure, providing a current state-of-the-art overview on the limits and pitfalls of indirect revascularization in the treatment of moyamoya vasculopathy. Keywords Moyamoya disease . Moyamoya syndrome . Indirect revascularization . EDAS . Bypass
Introduction Moyamoya is a chronic cerebrovascular disorder consisting in the bilateral stenosis or occlusion of the terminal portion of the internal carotid arteries and the proximal tracts of the anterior and middle cerebral arteries [1–3]. This condition can be classified into pure moyamoya disease (MMD), when no associated risk factor is identifiable, and moyamoya syndrome
* Marcello Scala [email protected] 1
Department of Neurosurgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
2
Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
3
Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, Genoa, Italy
4
Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
(MMS) or quasi-MMD, when the vasculopathy develops in association with clear risk factors [2, 4, 5]. Surgical treatment remains the cornerstone in patient management in order to reduce the risk ischemic or hemorrhagic sequelae [4, 6]. However, it has no significant impact on the pathogenic mechanisms underlying moyamoya vasculopathy [6]. Surgical techniques can be categorized as direct, indirect, or a combination of the two [7]. Extracranial-intracranial bypass (e.g., STA-MCA anastomosis) is generally the standard direct surgical procedure [8]. Indirect revascularization techniques employ a variety of tissues as a source of b
Data Loading...
