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Surgical management of moyamoya disease: a review

Ali A Baaj1, Siviero Agazzi, Zafar A Sayed

  • 1Department of Neurological Surgery, College of Medicine, University of South Florida, Tampa, Florida, USA.

Neurosurgical Focus
|April 2, 2009
PubMed

Insights

Moyamoya disease (MMD) is a progressive vascular condition affecting brain arteries. This review details surgical treatments, including direct and indirect bypass techniques, to manage MMD symptoms like strokes and bleeding.

Area of Science:

  • Neurology
  • Neurosurgery
  • Vascular Surgery

Background:

  • Moyamoya disease (MMD) is a rare, progressive cerebrovascular disorder characterized by stenosis of the distal internal carotid arteries and the circle of Willis.
  • MMD can lead to severe neurological deficits, including ischemic strokes in children and hemorrhagic strokes in adults.

Purpose of the Study:

  • To provide a comprehensive overview of the current surgical treatment options for Moyamoya disease.
  • To highlight the principles and techniques of both direct and indirect revascularization procedures for MMD.

Main Methods:

  • Review of existing literature on surgical management of Moyamoya disease.
  • Description of direct bypass techniques, focusing on superficial temporal artery-to-middle cerebral artery bypass.
  • Explanation of indirect revascularization methods involving the application of vascularized tissues to the cerebral cortex.

Main Results:

  • Direct bypass surgery, such as STA-MCA, is a primary treatment for MMD, aiming to restore cerebral blood flow.
  • Indirect revascularization techniques utilize tissues like muscle, pericranium, dura, or omentum to encourage new blood vessel growth (neoangiogenesis).
  • Both surgical approaches aim to reduce the risk of ischemic or hemorrhagic events in MMD patients.

Conclusions:

  • Surgical intervention is crucial for managing Moyamoya disease and preventing further neurological damage.
  • The choice between direct and indirect bypass depends on individual patient factors and surgical expertise.
  • Continued research and refinement of surgical techniques are essential for optimizing outcomes in MMD treatment.

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