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{{Moyamoya disease}}
{{Moyamoya disease}}
{{CMG}} {{AE}} {{VVS}}
{{CMG}} {{AE}} {{VVS}}
==Medical Therapy==
==Overview==
Drugs such as [[antiplatelet]] agents (''e.g.'', aspirin) are usually given to prevent clots, but surgery is usually recommended. Since moyamoya tends to affect only the  internal carotid artery and nearby sections of the adjacent anterior and middle cerebral arteries, surgeons can direct other arteries, such as the [[external carotid artery]] or the [[superficial temporal artery]] to replace its circulation. The arteries are either sewn directly into the brain circulation, or placed on the surface of the brain to reestablish new circulation after a few weeks. Although there is a 4% risk of stroke soon (30 days) after surgery, there is a 96% probability of remaining stroke-free over the next 5 years.<ref name="Scott">[http://content.nejm.org/cgi/content/full/360/12/1226 Moyamoya Disease and Moyamoya Syndrome], R. Michael Scott and Edward R. Smith, New England Journal of Medicine, 360:1226-1237, March 19, 2009</ref>
Drugs such as [[antiplatelet]] agents (''e.g.'', aspirin) are usually given to prevent clots, but surgery is usually recommended. Since moyamoya tends to affect only the  internal carotid artery and nearby sections of the adjacent anterior and middle cerebral arteries, surgeons can direct other arteries, such as the [[external carotid artery]] or the [[superficial temporal artery]] to replace its circulation. The arteries are either sewn directly into the brain circulation, or placed on the surface of the brain to reestablish new circulation after a few weeks. Although there is a 4% risk of stroke soon (30 days) after surgery, there is a 96% probability of remaining stroke-free over the next 5 years.<ref name="Scott">[http://content.nejm.org/cgi/content/full/360/12/1226 Moyamoya Disease and Moyamoya Syndrome], R. Michael Scott and Edward R. Smith, New England Journal of Medicine, 360:1226-1237, March 19, 2009</ref>
There are many operations that have been developed for the condition, but currently the most favored are the in-direct procedures EDAS, EMS, and multiple burr holes and the direct procedure STA-MCA. Direct [[superficial temporal artery]] (STA) to [[middle cerebral artery]] (MCA) bypass is considered the treatment of choice, although its efficacy, particularly for hemorrhagic disease, remains uncertain. Multiple [[burr hole]]s have been used in frontal and parietal lobes with good neovascularisation achieved.
The '''EDAS''' ([[encephaloduroarteriosynangiosis]]) procedure is a [[synangiosis]] procedure that requires dissection of a scalp artery over a course of several inches and then making a small temporary opening in the skull directly beneath the artery. The artery is then sutured to the surface of the brain and the bone replaced.
In the '''EMS''' ([[encephalomyosynangiosis]]) procedure, the [[temporalis]] muscle, which is in the temple region of the forehead, is dissected and through an opening in the skull placed onto the surface of the brain.
In the '''multiple burr holes''' procedure, multiple small holes (burr holes) are placed in the skull to allow for growth of new vessels into the brain from the scalp.
In the '''STA-MCA''' procedure, the scalp artery (superficial temporal artery or STA) is directly sutured to an artery on the surface of the brain (middle cerebral artery or MCA). This procedure is also commonly referred to as an EC-IC (External Carotid-Internal Carotid) bypass.
All of these operations have in common the concept of a blood and oxygen "starved" brain reaching out to grasp and develop new and more efficient means of bringing blood to the brain and bypassing the areas of blockage. The modified direct anastomosis and encephalo-myo-arterio-synagiosis play a role in this improvement by increasing cerebral blood flow (CBF) after the operation. A significant correlation is found between the postoperative effect and the stages of preoperative angiograms. It is crucial for surgery that the anesthesiologist have experience in managing children being treated for moyamoya as the type of anesthesia they require is very different from the standard anesthetic children get for almost any other type of [[neurosurgical]] procedure.


==References==
==References==
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Latest revision as of 15:19, 19 March 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]

Overview

Drugs such as antiplatelet agents (e.g., aspirin) are usually given to prevent clots, but surgery is usually recommended. Since moyamoya tends to affect only the internal carotid artery and nearby sections of the adjacent anterior and middle cerebral arteries, surgeons can direct other arteries, such as the external carotid artery or the superficial temporal artery to replace its circulation. The arteries are either sewn directly into the brain circulation, or placed on the surface of the brain to reestablish new circulation after a few weeks. Although there is a 4% risk of stroke soon (30 days) after surgery, there is a 96% probability of remaining stroke-free over the next 5 years.[1]

References

  1. Moyamoya Disease and Moyamoya Syndrome, R. Michael Scott and Edward R. Smith, New England Journal of Medicine, 360:1226-1237, March 19, 2009

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