Moyamoya disease in Yugoslavia: angiographic study

The angiographic findings in 31 Yugoslav moyamoya patients, 16 males and 15 females, including four children, were studied by conventional or digital subtraction angiography. The angiographic findings were reviewed for stenoocclusive lesions, form of the main cerebral arteries, transdural anastomoses, and basal vascular networks. There were 27 patients with bilaterally symmetrical or asymmetrical lesions and four with unilateral lesions. In two of these latter four patients, follow-up studies showed progression of the disease to the opposite side. Of 58 sides investigated, stenoocclusive lesions were localized above the origin of the anterior choroidal artery in 33 internal carotid arteries. Occlusions of the anterior and middle cerebral arteries were noted more frequently than stenoses: 89 vs. 27. The majority of the nests of abnormally dilated vessels (73 of 102) were localized in the ethmoidal region and basal ganglia. Analysis of distribution of the transdural collateral pathways to the brain discovered predominant participation of the middle meningeal and occipital arteries (43 of 55). Moyamoya disease in Yugoslavia predominantly affects the adult population, males and females equally, with the slowly progressive course typical for adults, and is mainly confined to the carotid fork and rarely extends to the posterior circulation.