Moyamoya Disease Surgery Options for Adults
Moyamoya Disease Surgery Options for Adults Moyamoya disease is a rare, progressive cerebrovascular disorder characterized by the narrowing or occlusion of the internal carotid arteries and their main branches at the base of the brain. This constriction leads to the formation of fragile abnormal blood vessels, which appear like a “puff of smoke” on imaging studies—hence the name “Moyamoya,” a Japanese term meaning “hazy.” While it is more common in children, adults can also develop this condition, often presenting with strokes or transient ischemic attacks (TIAs). Surgical intervention remains a cornerstone in managing Moyamoya disease, especially in adult patients, to prevent further ischemic events and improve cerebral blood flow.
In adults, Moyamoya disease often presents with symptoms like headaches, dizziness, weakness, or sudden neurological deficits due to ischemic strokes. Managing these symptoms involves not only medical therapy but also surgical revascularization procedures. The primary goal of surgery is to restore adequate blood flow to the brain by creating new pathways for blood to bypass the narrowed or blocked arteries.
There are two main categories of surgical options for adults with Moyamoya disease: direct and indirect revascularization procedures. Often, a combination of both is employed depending on the patient’s condition, vascular anatomy, and surgeon expertise. Moyamoya Disease Surgery Options for Adults
Direct revascularization involves creating a direct connection between an external artery and an intracranial artery to provide immediate blood flow. The most common technique is the superficial temporal artery to middle cerebral artery (STA-MCA) bypass. This procedure involves connecting a branch of the superficial temporal artery, located just under the scalp, directly to a cortical branch of the middle cerebral artery inside the skull. Because it offers immediate restoration of blood flow, this method is often preferred in adult patients, especially those at high risk of stroke.
Indirect revascularization techniques stimulate the development of new blood vessels over time by placing vascular-rich tissue in contact with the brain surface. Procedures such as encephaloduroarteriosynangiosis (EDAS) and encephalomyosynangiosis (EMS) involve attaching ti
ssues like the scalp artery or muscle to the brain surface, encouraging collateral vessel growth over months. These techniques are less invasive but require patience for the collateral circulation to develop.
In many adult cases, surgeons opt for a combined approach, performing both direct and indirect procedures to maximize the chances of improved cerebral perfusion. The choice depends on individual factors, including vascular anatomy, age, and the severity of arterial stenosis. Moyamoya Disease Surgery Options for Adults
Moyamoya Disease Surgery Options for Adults The decision to undergo surgery is made after thorough evaluation, including cerebral angiography, MRI, and other imaging studies that delineate the extent of arterial narrowing and collateral formation. Surgery aims not only to prevent future strokes but also to improve quality of life by reducing symptoms like headaches and transient neurological deficits.
While surgical procedures generally have good outcomes, they carry risks such as bleeding, stroke, or infection. Nonetheless, with experienced surgical teams and careful patient selection, the prognosis for adults with Moyamoya disease improves significantly post-surgery. Recovery involves rehabilitation and close follow-up to monitor for any recurrence or complications. Moyamoya Disease Surgery Options for Adults
In conclusion, adult Moyamoya disease management heavily relies on surgical revascularization procedures tailored to individual needs. Advances in microsurgical techniques continue to enhance the safety and efficacy of these interventions, offering hope for better neurological function and stroke prevention in affected adults. Moyamoya Disease Surgery Options for Adults
