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Outcome of revascularization in moyamoya disease: Evaluation of a new angiographic scoring system
Siddhartha Shankar Sahoo1, Ashish Suri1, Sumit Bansal1
1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Background:
Moyamoya disease (MMD) is a chronic progressive cerebrovascular occlusive disease affecting commonly the anterior circle of Willis. Matushima grade inadequately reflects the angiographic changes postrevascularization procedure.
Aims:
To analyze the clinical and angiographic outcome of revascularization procedures (direct [ST-middle cerebral artery (MCA) anastomosis] and indirect [encephalo-duro-arterio-myo-synangiosis (EDAMS)]) in MMD and validate a new angiographic scoring system.
Materials And Methods:
Retrospective study included symptomatic patients of MMD who underwent revascularization; both indirect and combined methods between January 2002 and April 2012. Follow-up angiography was done after at least 3 months. We devised a novel scoring system the "angiographic outcome score" (AOS) including reformation of distal MCA and anterior cerebral artery, regression of basal moyamoya vessels, leptomeningeal collaterals and overall perfusion. AOS was applied to the angiograms independently by a neuroradiologist and a neurosurgeon that were blinded toward its preoperative or postoperative status.
Results:
Totally 33 patients underwent 36 EDAMS and 4 combined procedures (EDAMS + ST-MCA bypass). The mean follow-up was 20 months. None had recurrent transient ischemic attack or fresh infarct. Postoperative AOS was significantly higher than preoperative AOS. The Spearman rho showed positive correlation between Matushima grade and postoperative AOS. Significant regression of basal moyamoya vessels and increase in number of loci of transdural collaterals was seen.
Conclusions:
EDAMS is a simple yet effective method of revascularization in both pediatric as well as adult age groups. AOS is a simple, precise and easily reproducible scoring system, which reflects the favorable angiographic changes after revascularization.
Insights
Encephalo-duro-arterio-myo-synangiosis (EDAMS) effectively revascularizes Moyamoya disease (MMD) patients. A new angiographic outcome score (AOS) accurately measures favorable changes after MMD revascularization.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Radiology
Background:
- Moyamoya disease (MMD) is a progressive cerebrovascular disorder affecting the circle of Willis.
- The Matushima grade has limitations in assessing post-revascularization changes in MMD.
Purpose of the Study:
- To evaluate the clinical and angiographic outcomes of direct and indirect revascularization procedures for MMD.
- To validate a novel angiographic scoring system for assessing MMD treatment efficacy.
Main Methods:
- Retrospective analysis of symptomatic MMD patients undergoing revascularization (EDAMS, ST-MCA bypass, or combined) from 2002-2012.
- Development and application of the "angiographic outcome score" (AOS) assessing MCA/ACA reformation, moyamoya vessel regression, collaterals, and perfusion.
- Independent blinded assessment of AOS by neuroradiologist and neurosurgeon.
Main Results:
- 33 patients underwent 40 revascularization procedures with a mean 20-month follow-up.
- No recurrent ischemic events or new infarcts were observed post-procedure.
- Postoperative AOS was significantly higher than preoperative AOS, correlating with Matushima grade and showing improved perfusion and collateralization.
Conclusions:
- Encephalo-duro-arterio-myo-synangiosis (EDAMS) is an effective revascularization technique for MMD in pediatric and adult patients.
- The novel angiographic outcome score (AOS) is a precise, reproducible tool for evaluating favorable angiographic changes after MMD revascularization.
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