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Surgical techniques and indications for treatment of adult moyamoya disease

Vincent N Nguyen1, Kara A Parikh1, Mustafa Motiwala1

  • 1Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, TN, United States.

Frontiers in Surgery
|September 5, 2022
PubMed

Insights

Moyamoya disease (MMD) in adults leads to progressive neurological decline and increased mortality. Surgical revascularization, using various bypass techniques, is crucial for treatment and improved outcomes.

Area of Science:

  • Neurology
  • Neurosurgery
  • Vascular Surgery

Background:

  • Moyamoya disease (MMD) is a progressive cerebrovascular condition characterized by internal carotid artery stenosis.
  • Adults with MMD face significant neurological and cognitive deficits, with higher mortality rates compared to pediatric cases.
  • Surgical intervention is the primary treatment to halt MMD progression and enhance patient outcomes.

Purpose of the Study:

  • To review the indications for surgical treatment in adult Moyamoya disease.
  • To detail various extracranial-to-intracranial (EC-IC) bypass techniques for MMD revascularization.
  • To provide technical insights for performing different bypass procedures.

Main Methods:

  • Review of current literature on Moyamoya disease treatment in adults.
  • Discussion of surgical indications based on patient age, hemodynamics, and neurological status.
  • Step-by-step description of indirect, direct, and combined EC-IC bypass techniques.

Main Results:

  • Surgical revascularization is essential for managing adult Moyamoya disease.
  • The choice of bypass technique depends on individual patient factors and affected brain regions.
  • Detailed surgical techniques and pearls are presented for effective revascularization.

Conclusions:

  • Surgical treatment is indicated for adult Moyamoya disease to prevent progression and improve outcomes.
  • Tailoring bypass techniques to patient-specific needs is critical for successful revascularization.
  • This review offers guidance on surgical indications and procedural execution for adult MMD.
Keywords:
bypasscerebrovascularindicationsmoyamoya diseaserevascularizationsurgerytechniques

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