Possible effectiveness of extensive indirect cerebral revascularisation surgery for the hemorrhagic event prevention in ntoymoya disease (based on the radiological observation)

초록

Background: Although Indirect cerebral revascuarization has been known to be effective for improving cerebral ischemia, its role in the prevention of hemorrhagic event is still controversial. We performed this study to clear the sources of hemorrhagic events and to evaluate the possible effectiveness of revascularization for its prevention. Methods: The authors reviewed a consecutive series of 128 patients with moyamoya syndrome. We analyzed their hemorrhagic or ischemic patterns and their angiographic characteristics as well. 67 cerebral revascularization surgeries (53 extensive indirect revascularization, 11 minimal indirect revascularization, 3 direct revascularization) has been performed in 44 patients (11 hemorrhagic type, 33 ischemic type). Postoperative angiography had been done in 38 sides of 24 patients. We analyzed postoperative change of moyamoya vessel in surgically treated patients. Results: Thirty two patients had been presented with cerebral hemorrhage and 93 had been presented with cerebral ischemia. Three patients had been presented with both. Hemorrhage occurred mainly in the ventricle (14 patients), thalamus (9) and basal ganglia (6), where maximal hemodynamic loading existed. Cerebral infarction had been identified in 56 patients and they occurred mainly in the borderzone area (96.7% of patients), which suggested that infarction had developed hemodynamically. No cerebral infarction had been identified in the rest of ischemic type patients. There was no difference between hemorrhagic and ischemic type in the collateral development pattern on the DSA. Moyamoya vessels had been regressed in all of extensive indirect surgery group but did not disappeared completely in the minimal indirect surgery group and direct surgery group. Conclusion: Considering that most Hemorrhagic events had occurred around the maximal hemodynamic loading area such as the junction between ventripetal artery and ventrifugal dysplastic artery and such dyspla