Abstract WP170: Long Time Follow Up Of Patients With Moyamoya Disease Treated By Multiple Burr Hole Surgery
Background The best revascularization surgery and its long term result for Moyamoya disease (MMD) remains unclear. From the 1980’s we have been performed Multiple Burr Hole Operation (MBHO, see figure). We report on the incidence of stroke in the long-term follow up.
Materials and Methods This study includes 46 patients with MMD treated in Hyogo Brain and Heart Center, Japan. There were 29 female and 17 male patients with a mean age of 40 years. The initial symptom was cerebral ischemia in 29 patients, hemorrhage in 15, and other in 2, respectively. The average follow-up period was 10.8 years. Evaluation of cerebral hemodynamics was performed in 32 cases. Revascularization surgery was performed in 39 patients. Among them, 31 cases were treated with MBHO. 7 cases were followed without any surgical procedures.
Results 12 patients (26%) suffered recurrent strokes in the follow-up period. The recurrent rate of stroke after diagnosis of MMD was 3.0% /patient-year. In the patients with initial ischemic presentation, MBHO provided similar stroke prevention comparing with direct surgery (27% vs. 25%). Poor CBF and Cerebral Vasoriactivity (CVR) were the statistically significant risk factors for recurrent stroke (OR=11, see figure, p=0.04).
Discussion/Conclusion MBHO could provid similar long-term results compared with direct bypass in patients with ischemic MMD. Evaluation of cerebral hemodynamics may predict future strokes. MBHO revealed to be a useful method as it is less invasive and can be easily done, performed in any place, and added to any other revascularization surgery.
- © 2012 by American Heart Association, Inc.