1981 Volume 10 Pages 265-269
Pathophysiology of moyamoya disease is still obscure. In recent years, surgical treatments for this disease have been reported by several authors, especially for the case with ischemic attacks. Five cases (4 children, 1 adult) were reported in correlation with the changes in postoperative angiographical findings. In four cases STA-MCA anastomosis was performed on both sides and in one case encephalo-myo-synangiosis was made bilaterally. Representive cases are as follow.
Six year-old boy presented with motor aphasia and right hemiparesis on admission. Four months prior to admission he experienced progressive left hemiparesis which improved remarkably thereafter. The STA-MCA anastomosis was performed bilaterally. Right carotid angiogram revealed improved cerebral circulation over the territory of right middle cerebral artery and diminished moyamoya vasculatures one year after the surgery.
Six year-old girl showed progressive left hemiparesis which was remaining slightly on admission. STA-MCA anastomosis was performed on both sides. Despite good circulation through bilateral STAs was noted in angiograms made 6 weeks after the operation, angiograms made one year after the surgery revealed poor patency of anastomosis and major blood supply to the territory of middle cerebral artery seemed to be through middle meningeal arteries which became prominent. Although stenosis of C-1 segment of both internal carotid arteries was aggravated and the artery was completely occluded at C-2 segment bilaterally, moyamoya vasculatures were diminished.
Development of anastomosis between meningeal arteries and cerebral arteries was postoperatively in 9 out of 10 cerebral hemispheres, irrespective of the patency of STAs. Preoperative symptoms were improved in all cases except for motor aphasia in one case. Ischemic attack has never been observed in all cases during the follow-up period for 5 to 24 months.
In view of the diminution of moyamoya vasculatures and improvement of symptoms, the surgical treatment of moyamoya disease seems to be justified to prevent further ischemic attacks.
