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Moyamoya disease in Mexico: our experience
E Nathal1, A Serrano-Rubio1, E Maciel2
1Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico.
Introduction:
Moyamoya disease (MD) is a progressive, occlusive disease of the arteries of the anterior cerebral circulation that may cause ischaemia or haemorrhage. Patient management aims to prevent new cerebrovascular events through surgical revascularisation and/or pharmacological treatment.
Materials And Methods:
We studied a series of 17 patients with MD (n = 14) or moyamoya syndrome (MS; n = 3), who were evaluated between January 1989 and December 2016; 11 patients were women and 6 were men. Thirteen patients had definitive MD (76%), one had unilateral MD (5.2%), and 3 had MS (18%). The condition manifested as intraparenchymal haemorrhage (in 35.2% of patients), brain ischaemia (29.4%), subarachnoid haemorrhage (17.6%), seizures (11.7%), and headache with no associated haemorrhage (1 patient).
Results:
Ten patients (58.8%) underwent revascularisation and 7 (41.2%) received pharmacological treatment. All patients were evaluated with the modified Rankin Scale (mRs) at admission and at the last consultation; mRs scores were significantly lower in the group undergoing surgery (P < .04). During follow-up, none of the patients undergoing revascularisation experienced recurrences, whereas 2 patients receiving pharmacological treatment did experience a new vascular event (one ischaemic and one haemorrhagic) (P < .05). No significant differences were observed between the treatment outcomes of different revascularisation techniques.
Conclusions:
Although our population has different demographic characteristics from those of other non-Asian populations, ours is the largest published series of Hispanic individuals with MD. Our results support the use of revascularisation procedures to improve these patients' neurological status and to prevent new cerebrovascular events.
Insights
Surgical revascularisation significantly lowers disability scores and prevents recurrent vascular events in moyamoya disease (MD) patients. This study highlights revascularisation as a key treatment to improve neurological outcomes for MD.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Medicine
Background:
- Moyamoya disease (MD) is a progressive occlusive condition affecting anterior cerebral circulation, leading to ischemia or hemorrhage.
- Current management focuses on preventing cerebrovascular events via surgical revascularization or pharmacologic therapy.
Purpose of the Study:
- To evaluate the efficacy of surgical revascularization versus pharmacologic treatment in managing moyamoya disease (MD) and moyamoya syndrome (MS).
- To assess the impact of treatment on neurological status and recurrence of vascular events in a Hispanic patient cohort.
Main Methods:
- Retrospective study of 17 patients (14 MD, 3 MS) diagnosed between 1989 and 2016.
- Patients were treated with either surgical revascularization (10 patients) or pharmacologic therapy (7 patients).
- Outcomes were assessed using the modified Rankin Scale (mRs) and monitoring for recurrent vascular events.
Main Results:
- Surgical revascularization resulted in significantly lower mRs scores compared to pharmacologic treatment (P < .04).
- No recurrences were observed in patients who underwent revascularization, while 2 patients on pharmacologic treatment experienced new vascular events (P < .05).
- No significant differences in outcomes were noted among various revascularization techniques.
Conclusions:
- Surgical revascularization is effective in improving neurological status and preventing recurrent cerebrovascular events in patients with moyamoya disease.
- This study represents the largest published series of Hispanic individuals with MD, supporting revascularization as a primary treatment strategy.
- The findings underscore the importance of surgical intervention for better patient outcomes in moyamoya disease.
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