MULTIPLE BURR-HOLE OPERATION FOR ADULT MOYAMOYA DISEASE

Excellent results from multiple burr-hole operations for adult moyamoy a disease are reported in this study. Ten patients had between one and four burr holes (mean 2.1) drilled in each hemisphere. In four patien ts new burr holes were added on the opposite side after depression of cerebral blood flow (CBF) was detected by follow-up single-photon emis sion computerized tomography imaging of the brain with N-isopropyl-p-[ I-123]iodoamphetamine. The postoperative follow-up period ranged from 6 to 62 months (mean 34.7 months). Beginning at 6 months postsurgery, angiograms disclosed rich neovascularization at 41 of 43 bun holes, fi rst from the middle meningeal artery, then fi om the superficial tempo ral artery. Neovascularization did not occur at two burr holes at whic h there was subdural effusion and local cerebral atrophy, respectively . Progression of stenosis of the major vessels was seen in six patient s. Moyamoya vessels were decreased at six sites in four patients. The CBF study revealed that the reactivity to acetazolamide improved in al l six patients tested. Transient ischemic attacks disappeared in all s ix patients presenting with this symptom, and preoperative symptoms im proved in both of the patients who presented with cerebral infarction and in both patients with intraventricular hemorrhage. There was no mo rtality or morbidity, and no new neurological deficits or rebleeding d eveloped during the followup period. The authors strongly recommend th e multiple burr-hole operation as the surgical treatment of choice for adult moyamoya disease because of its safety and effectiveness.