Specific clinical features and one-stage revascularization surgery for moyamoya disease with severe cerebral ischemia in
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ORIGINAL ARTICLE - VASCULAR NEUROSURGERY - OTHER
Specific clinical features and one-stage revascularization surgery for moyamoya disease with severe cerebral ischemia in the territory of posterior cerebral artery Hisayasu Saito 1,2 & Daina Kashiwazaki 1 & Haruto Uchino 1,2 & Shusuke Yamamoto 1 & Kiyohiro Houkin 2 & Satoshi Kuroda 1,2 Received: 12 July 2020 / Accepted: 7 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background There are no reports describing the surgical procedure for moyamoya disease (MMD) patients with severe cerebral ischemia in the territory of the posterior cerebral artery (PCA) at initial presentation. In this study, therefore, we describe their clinical and radiological features and clinical results of one-stage revascularization surgery for both anterior and posterior circulation. Methods This study included 6 MMD patients who had severe cerebral ischemia in the PCA territory and underwent one-stage revascularization surgery for both anterior and posterior circulation. Of these, one patient underwent it on both sides. Their clinical and radiological data were precisely analyzed. Compared with usual procedure, craniotomy was extended towards the temporo-parietal area more widely. The parietal branch of superficial temporal artery (STA) was anastomosed to the angular or posterior temporal artery, while the frontal branch was anastomosed to the frontal branch of MCA. Ultimate indirect bypass was added. Their clinical and radiological outcomes were evaluated. Results Their neurological symptoms included visual and speech disturbance as well as numbness of the extremities. Cerebral infarct was distributed in the posterior temporal, parietal, and/or occipital lobe. Cerebral hemodynamics and metabolism were also impaired in the same regions. These findings were completely different from those in MMD patients without PCA lesion. Postoperative course was uneventful, and none of them recurred stroke during a mean follow-up period of 10.5 years. Surgical collaterals widely provided blood flow to the entire hemispheres, including the occipital lobe. Cerebral hemodynamics and metabolism markedly improved after surgery. Conclusion One-stage revascularization surgery for both anterior and posterior circulation is feasible and effective to prevent future stroke in MMD patients with severe cerebral ischemia in the PCA territory at initial presentation. Keywords Moyamoya disease . Posterior cerebral artery . Surgical revascularization . Cerebral ischemia . Occipital lobe . Temporal lobe
Introduction This work has not been presented in any forms and has not been published in any journals. This article is part of the Topical Collection on Vascular Neurosurgery Other * Satoshi Kuroda [email protected] 1
Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science for Education, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
2
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Moyamoy
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