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KMID : 1005420100120030182
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Journal of Cerebrovascular and Endovascular Neurosurgery
2010 Volume.12 No. 3 p.182 ~ p.189
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Comparison of the complications arising after superficial temporal artery-middle cerebral artery anastomosis in adult moyamoya disease and atherosclerotic disease
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Kim Yong-Chan
Kim Seung-Hyun
Bang Jae-Seung
Hwang Gyo-Jun
Kwon O-Ki
Oh Chang-Wan
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Abstract
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Objective : To assess the results of superficial temporal artery-middle cerebral artery anastomosis (SMA) in atherosclerotic disease (ASD) and in adult moyamoya disease (MMD) by comparing the complications that arise.
Methods : We retrospectively reviewed patients with ASD or adult MMD treated by means of SMA, between December 2000 and December 2006, at our neurovascular center. During this period, we performed 115 SMAs on 108 patients: 61 on ASD patients (61 SMAs; the ASD group) and 47 on adult MMD patients (54 SMAs; the MMD group).
Results : We found a higher incidence of postoperative 1 month neurological deficits (P1NDs) and a lower incidence of transient neurological deficits (TNDs) in the MMD group than in the ASD group (p-value=0.047). Patients with a preoperative stroke (cerebral infarction/hemorrhage) history were more likely to develop P1ND than were the patients with a preoperative history of transient ischemic attack (TIA), in both the ASD (p-values=0.012 and 0.033, respectively) and MMD groups (p-values=0.000 and 0.015, respectively), regardless of overall patients (n=108) and single SMA group (n=62). Delayed seizure (seizure occurring > 1 month after SMA) occurred only in 8 MMD patients (8/47, 17.0%; p-value=0.003) out of all 108 patients and in 2 patients (2/10, 20%, p-value=0.014) out of the single SMA group. Major morbidity at the final follow-up period (Karnofsky performance scale (KPS)≤70) was 6.4% (3 patients) in 47 MMD patients and 0% in 61 ASD patients. Minor morbidity ( 80≤KPS≤90) was also 6.4% (3 patients) in 47 MMD patients and 1.6% (1 patient) in 61 ASD patients.
Conclusion : The present study suggests that, in both ASD and MMD, the presence of preoperative stroke (infarction) correlated strongly with the postoperative P1ND. In addition, it may also be suggested that complex and protracted surgical modalities may have influences on the incidence of P1ND. Furthermore, we found that only MMD patients experienced delayed seizure attacks after SMA, and we think this may be related to the delayed formation of angiogenesis, which may increase irritation to cortex.
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KEYWORD
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STA-MCA anastomosis, Atherosclerotic disease, Moyamoya, disease, Complication
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