Surgical Treatment for Adult Patients with Moyamoya Disease

-With Special Reference to Hemorrhagic Type-

Abstract

This report reviews the clinical courses of 42 adult patients with Moyamoya disease and in whom onset occurred after the age of 16. Twenty-five of the 42 patients presented with hemorrhagic type disease while the remaining 17 had non-hemorrhagic type. Twenty-five percent of the hemorrhagic type patients who underwent bypass surgery experienced rebleeding postoperatively, while 21% of those without bypass surgery had recurrent hemorrhage. There was no significant difference in the rebleeding rates between the groups with and without bypass surgery. Bypass surgery did not demonstrate any effect in preventing a recurrence of intracranial hemorrhage in these cases.
This report also reviews the long-term clinical results of 28 adult Moyamoya patients who had ischemic symptoms in childhood. Fourteen percent of the patients had hemorrhagic attacks as adults. None had undergone bypass surgery before the hemorrhagic attack. On the other hand, 18 patients who underwent bypass surgery in the pediatric period have since shown no hemorrhagic attack until present. The above findings therefore suggest that bypass surgery performed in the pediatric period may possibly prevent future incidences of intracranial hemorrhage.