Surgical Treatment of “Moyamoya” Disease with Bilateral Hemispheric Ischemic Symptoms

-Which side should be operated on first?-

Abstract

In this paper, the authors discuss which side should be first operated on in patients with “Moyamoya” disease with bilateral hemispheric symptoms. Fifty-nine patients (33.7%) out of 175 cases with “Moyamoya” disease were found, on the first examination to have bilateral hemispheric ischemic symptoms (including TIA and RIND). These patients underwent bilateral surgical revascularization according to the following policy: (1) In principle the dominant (left) hemisphere should be operated on first. (2) In the following cases the non-dominant (right) hemisphere should be operated on first: (a) When there is little likelihood of the neurological recovery of the left hemisphere. (b) The right hemispheric symptoms are worse or more progressive than the left. (c) Others All 35 patients who underwent operation first on the left hemispher and 23 out of 24 patients who underwent operation first on the right hemisphere have improved in ADL compaired with the preoperative state. There was only one patient whose left hemispheric symptoms at the second (left side) operation had become worse than at the first (right side) operation. The policy seems to be proper.