From the Department of Neurosurgery, Shimane Medical University, Izumo,
Japan (Y.O.), and the Department of Neurosurgery, Chugoku Rousai Hospital
(T.S., M.N., K.Y., T.Y., C.Y.), Hiroshima, Japan.
Correspondence to Yoshikazu Okada, MD, Department of Neurosurgery, Shimane Medical University, 1–89 Enya-cho, Izumo, Shimane 693, Japan.
Background and Purpose—The
efficacy of superficial temporal artery–middle cerebral artery
(STA-MCA) anastomosis in adult moyamoya disease was evaluated by
clinicopathophysiological studies.
Methods—Fifteen patients with cerebral ischemic
attacks (ischemia group) and 15 patients with intracranial
hemorrhages (hemorrhage group) were investigated.
Clinicoangiographic features and regional cerebral blood flow (rCBF) of
the MCA territory were preoperatively and postoperatively investigated,
and cortical arterial pressure (CAP) and anastomotic blood
flow (AF) were intraoperatively measured.
Results—In the ischemia group, the preoperative
rCBF of 38.4 mL/100 g per minute was significantly increased to 42.1
mL/100 g per minute with a diminution of angiographic moyamoya
vessels in 67% of patients after surgery. The mean CAP and AF were
25.6 mm Hg and 34.7 mL/min, respectively. Proximal and distal
cerebral vascular resistance (PCVR=[Mean Systemic Arterial
Blood Pressure-Mean CAP]/rCBF and DCVR=[Mean CAP/rCBF]) were 1.78
and 0.68, respectively. One patient died
perioperatively as a result of
intracerebral hemorrhage. During follow-up
(mean, 67 months), 12 of 14 patients recovered without neurological
deficits, 1 was moderately disabled because of the initial insult, and
another patient experienced an intracerebral
hemorrhage but recovered fully. In the hemorrhage
group, the preoperative rCBF of 38.0 mL/100 g per minute was
significantly increased to 42.7 mL/100 g per minute with a diminution
of moyamoya vessels in 60% after surgery. The mean CAP and AF were
29.1 mm Hg and 24.1 mL/min, respectively. PCVR and DCVR were 1.72
and 0.77, respectively. One patient became hemiparetic because of
perioperative intracerebral
hemorrhage. During follow-up (mean, 94 months), 3 patients had
fatal intracranial hemorrhages, 10 had good recoveries, and 2
had moderate disabilities.
Conclusions—This study revealed a high PCVR and a very low
DCVR in both the ischemia and hemorrhage groups of
patients. STA-MCA anastomosis partially normalized cerebral circulation
and decreased moyamoya vessels but did not completely prevent
rebleeding.
© 1998 American Heart Association, Inc.
Original Contributions
Effectiveness of Superficial Temporal Artery–Middle Cerebral Artery Anastomosis in Adult Moyamoya Disease
Cerebral Hemodynamics and Clinical Course in Ischemic and Hemorrhagic Varieties
Key Words: bypass surgery • cerebral blood flow • cerebral hemorrhage • moyamoya disease • vascular resistance
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