SURGICAL THERAPY FOR ADULT MOYAMOYA DISEASE CAN SURGICAL REVASCULARIZATION PREVENT THE RECURRENCE OF INTRACEREBRAL HEMORRHAGE

Background and Purpose It is well recognized that revascularization su rgery using direct and/or indirect bypass provides effective surgical management for pediatric moyamoya disease. However, surgical treatment of the adult hemorrhagic type remains controversial. In this study, t he effect of surgery for adult moyamoya disease was investigated. Meth ods We analyzed 35 patients with adult moyamoya disease (patient age, over 20 years), 24 patients with initial onset of intracerebral hemorr hage, and 11 patients with initial onset of cerebral ischemia who unde rwent both direct bypass surgery of the superficial temporal artery to the middle cerebral artery anastomosis and indirect revascularization of encephalo-duro-arterio-myo-synangiosis. Results Of 24 patients wit h hemorrhagic-type disease, 3 showed rebleeding; of 11 patients with t he ischemic type, 2 showed intracerebral hemorrhage after surgery. Ove rall, 5 of 35 patients (14.3%) had hemorrhage after revascularization surgery (mean follow-up period, 6.4 years), Postoperative angiography revealed that direct anastomosis is effective whereas indirect revascu larization is not always effective for adult moyamoya disease. Moyamoy a vessels, which are supposed to be responsible for hemorrhage, decrea sed in 25% of patients. Conclusions Revascularization surgery cannot a lways pre vent rebleeding. However, a decrease in moyamoya vessels was induced by surgery, which may reduce the risk of hemorrhage more effe ctively than conservative treatment. In cases of adult moyamoya diseas e, direct bypass is particularly important, since the indirect revascu larization is not as useful in adult cases as in pediatric cases.