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Cerebral Revascularization Accelerates the Angiographic Staging Progression of the Operated Hemisphere in a Pediatric Patient With Moyamoya Disease

Yu, Le-Bao, MD*,†,‡,§; Ma, Yong-Gang, MM*,†,‡,§; Zhang, Dong, MD*,†,‡,§

Journal of Craniofacial Surgery: June 2019 - Volume 30 - Issue 4 - p 1180–1183
doi: 10.1097/SCS.0000000000005256
Clinical Studies

Background and Objective: Angiographic staging progression in the operated hemisphere of patient with moyamoya disease (MMD) is a common phenomenon that neurosurgeons may encounter. However, few studies have been carried out to demonstrate the correlation between the operation and angiographic staging progression. This study aimed to reveal whether cerebral revascularization would affect the stage progression in patient with MMD.

Methods: A total of 20 pediatric patients with bilateral MMD were included in this study. All enrolled patients were at the similar Suzuki angiographic staging on bilateral hemispheres and cerebral revascularization was performed in unilateral hemisphere. Angiographic examination was performed in the first year after the operation to evaluate the progression of the lesions.

Results: Cerebral revascularizations including direct bypass or encephaloduroarteriosynangiosis were performed in 20 hemispheres. During the follow-up, the incidence of stage progression in the operated hemisphere was significantly higher than in the contralateral side (80.0% versus 20.0%, respectively; P = 0.036) and the interval of disease progression was significantly shorter in the operated side than in the contralateral side (mean interval time, 7.3 versus 10 months). Earlier Suzuki stage on hemisphere represented faster pace of stage progression compared with server Suzuki stage (OR = −0.612, P = 0.004), while neoformative collaterals had not significant correlation with the progression pace. The leptomeningeal collaterals from the posterior circulation decreased in almost all operated hemisphere, while gradually increasing in the contralateral hemisphere. Symptoms were improved in all patients after operation.

Conclusion: Cerebral revascularization would significantly accelerate the angiographic staging progression on the treated hemisphere, while it would not cause the deterioration of the patient's condition. The progression pace was associated with Suzuki stage.

*Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University

China National Clinical Research Center for Neurological Diseases (NCRC-ND)

Center of Stroke, Beijing Institute for Brain Disorders

§Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.

Address correspondence and reprint requests to Dr Dong Zhang, MD, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China; E-mail:

Received 16 September, 2018

Accepted 19 November, 2018

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.