Optimal surgical treatment for moyamoya disease in adults: direct versus indirect bypass.

@article{Starke2009OptimalST,
  title={Optimal surgical treatment for moyamoya disease in adults: direct versus indirect bypass.},
  author={Robert M. Starke and Ricardo J. Komotar and Edward Sander Connolly},
  journal={Neurosurgical focus},
  year={2009},
  volume={26 4},
  pages={
          E8
        },
  url={https://api.semanticscholar.org/CorpusID:207662393}
}
The authors review the literature concerning the optimal surgical treatment of adult patients with moyamoya disease and find no randomized trials to assess the efficacy of any single surgical treatment.
View on PubMed
thejns.org
68 Citations
Highly Influential Citations
2
Background Citations
8
Methods Citations
1
Results Citations
1

68 Citations

Direct versus indirect revascularization in the treatment of moyamoya disease.

Modified EDAS and EIAB both result in positive outcomes for symptomatic adults with MMD, and the authors propose mEDAS, a simpler and less strenuous surgery with a lower risk of complications, as a sufficient and safe treatment option for symptomomatic adultswith MMD.

Surgical treatment of moyamoya disease in adults: combined direct and indirect vs. indirect bypass surgery.

EDAGS is a very reliable alternative to combined bypass in adult MMD, however, randomized clinical trials are needed to assess the long-term efficacy of any bypass surgery in adult patients with MMD.

Surgical Treatment of Moyamoya Disease

Surgical treatment should be considered in moyamoya patients, even if asymptomatic, particularly in the paediatric age group, because children seem to benefit most from indirect techniques.

Direct versus indirect revascularization procedures for moyamoya disease: a comparative effectiveness study.

Direct revascularization procedures are inferior in terms of quality-adjusted life years in both adults at 4 years and children at 5 and 10 years postoperatively, respectively, suggesting that indirect and combination procedures may offer optimal results at long-term follow-up.

Surgical management of Moyamoya disease and syndrome: Current concepts and personal experience.

Treatment of Moyamoya disease in the adult population with pial synangiosis.

Pial synangiosis is a safe and durable method of cerebral revascularization in adult patients with moyamoya and can be considered as a potential treatment option for moyAMoya disease in adults.

Bypass surgery versus medical treatment for symptomatic moyamoya disease in adults.

During the treatment of symptomatic MMD in adults, bypass surgery reduces stroke recurrence for the hemorrhagic type, but it does not do so for the ischemic type, and the best choice of bypass methods in adults with MMD is uncertain.

History of the development of surgical treatments for moyamoya disease.

A review of the historical development and efficacy of each procedure will aid surgeons in selecting the most appropriate surgical procedure for patients of different ages with different symptoms and disease severities.

Indirect Revascularization Procedures for Surgical Treatment of Moyamoya Disease in Pediatric Patients

It is demonstrated that indirect revascularization (EDAS and Bifrontal EGS) with arachnoid opening should be considered as a primary line of treatment once diagnosis of MMD is made in pediatric age group.

Outcome of repeat revascularization surgery for moyamoya disease after an unsuccessful indirect revascularization. Clinical article.

Repeat revascularization procedures are effective for patients who are clinically symptomatic and have inadequate collateral vessels following indirect procedures, and the choice of procedure depends on the operative findings and the status of donor and recipient vessels.
...

45 References

Indirect revascularization for moyamoya disease: is there a beneficial effect for adult patients?

The surgical treatment of childhood moyamoya disease.

The results of surgical treatment for moyamoya disease are encouraging and the authors believe that it should be offered to all pediatric patients in the progressive stage of the disease.

A new surgical treatment of moyamoya disease in children: a preliminary report.

Moyamoya disease‐‐a review.

Treatment with perivascular sympathectomy and superior cervical ganglionectomy may be useful but more investigation needs to be carried out into the pathogenesis of the disease before more definitive therapy is realized.

Effects of surgical revascularization on outcome of patients with pediatric moyamoya disease.

Combined surgery (STA-MCA bypass with EDAMS) for pediatric moyamoya disease was effective in reducing the risk of postoperative ischemic attacks compared with indirect surgery and surgical revascularization may be effective in preventing intellectual deterioration and improving overall outcome.

Surgical therapy for adult moyamoya disease. Can surgical revascularization prevent the recurrence of intracerebral hemorrhage?

Postoperative angiography revealed that direct anastomosis is effective whereas indirect revascularization is not always effective for adult moyamoya disease, which may reduce the risk of hemorrhage more effectively than conservative treatment.

The Moyamoya syndrome and the neurosurgeon.

If there is a progressive neurological deterioration as a consequence of an inadequate collateral circulation, the creation of a new collateral vascular channel by way of anastomosis between the superficial temporal artery and a branch of the middle cerebral artery is proposed.

Surgical treatment of moyamoya disease in pediatric patients--comparison between the results of indirect and direct revascularization procedures.

EDAS can be done easily and safely on small children with moyamoya disease, but STA-MCA anastomosis with EMS is considered to be more appropriate, whenever possible.

Long-term results of surgically treated Moyamoya disease

Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis.

Following pial synangiosis, the majority of pediatric patients with moyamoya syndrome stop having strokes and TIAs, and they appear to experience an excellent long-term prognosis.