Surgical Treatment in Moyamoya Disease

Abstract

We have experienced 100 cases of Moyamoya disease these 18 years. Symptoms due to cerebral ischemia such as motor disturbance, mental handicap and so on were observed in 31 (85%) out of 46 children cases and in 17 (37%) out of 54 adult cases. Perivascular sympathectomy (PVS) and superior cervical ganglionectomy (SCG) were performed on these cases in order to increase the cerebral blood flow.
As a result, improvement of symptoms were observed in 19 (61.3%) out of 31 children cases and 8 (47.1%) out of 17 adults cases without any particular complications. These results are relatively good compared with those of intracranial surgical procedures such as STA-MCA anastomosis, encephalo-myo-synagiosis and encephalo-duro-arterio-synangiosis, which are very often performed in Japan recently.
Therefore, we advocate that PVS and SCG should be the first choice for the surgical treatment in Moyamoya disease. If no improvement is observed in spite of surgical operation at the neck, intracranial procedures such as STA-MCA anastomosis, encephalo-myo-synangiosis and so on might be available.