Surgical Treatment of "Moyamoya Disease" with Ischemic Symptoms - Which Factor is More Important, Recent Stroke Event or Hemodynamic State ? -

Objective : Moyamoya disease is well known to a bilateral disease. But it is not necessarily that both sides are same stage and same severity of hemodynamic state. There is no clear evidence of determining which side should be opera ted upon first, thus we report our criteria for determining priority of operation side in patients with symptoms of bilateral hemispheric involvement. Methods : Between 1995 and 2005, twenty-three patients underwent superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis with/without encephalo-myo-synangiosis (EMS). We classified them into three groups. Recent stroke side showed worse hemodynamic state in group A, same hemodynamic state in group B and better hemodynamic state in group C. All patients underwent surgical revascularization according to the policy of priority for recent stroke side treatment. Result : There are eighteen cases in group A, four cases in group B and one case in group C. All the patients in group A were doing well. Only one case in group B developed contralateral cerebral infarction after operation. In group C, the only one case resulted in contralateral cerebral infarction after operation. Conclusion : In principle, the severity of hemodynamic state is more important for determining the first operation side