Clinical investigation of the acute cerebrovascular disease-Part 3

Timing and effect of operation in occlusion of the circle of Willis in children

Abstract

There have been many papers about occlusion of circle of Willis since 1956, when Kudo et al. reported the first case. However its causal genesis and treatment are still controversial. Therefore, an investigation was made in order to clarify the indication and timing of the operation for occlusion of circle of Willis considering from cerebral angiograms, CT findings and pre-and-post operative clinical symptoms.
Eight infantile cases out of eighteen cases of occlusion of the circle of Willis were operated in our university hospital from 1977 to 1980. These cases were classified into 3 types. Type 1 means early stage of occlusion of circle of Willis. Occlusive lesion is still confined in the anterior half of the circle of Willis and development of Moyamoya vessels or collateral circulation is incomplete. CT reveals within normal limits or mild hemiatrophy.
Type 2 means typical cases of occlusion of circle of Willis with Moyamoya vessels or transdural anastomosis. CT reveals watershed infarction or cortical atrophy. Transit type means cases resemble to adult type. Cases of type 1 with operation (STAMCA anastomosis +EMS) improved well immediately after operation, and postoperative angiogram revealed marked increase of blood flow in MCA territory. However, cases of type 1 without operation became type 2. Cases of transit type were not improved well by operation. Therefore, timing and indication of the operation for occlusion of circle of Willis are good during the stage of type 1.