• World Neurosurg · Aug 2022

    A preliminary report of one session treatment with cranioplasty and STA-MCA bypass for hemorrhagic MMD patients with skull defect.

    • Gang Wang, Zhibin Wang, Yunyu Wen, Siyuan Chen, Mingzhou Li, Guozhong Zhang, Huiping Yu, Shichao Zhang, Haiyan Xu, Songtao Qi, and Wenfeng Feng.
    • Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China; People's Hospital of Huazhou, Maoming City, Guangdong Province, China.
    • World Neurosurg. 2022 Aug 1; 164: 276-280.

    ObjectiveThe objective of this study was to conduct a retrospective analysis of the safety and efficacy of one-session treatment with cranioplasty and superficial temporal artery-middle cerebral artery (STA-MCA) bypass after decompressive craniectomy in hemorrhagic moyamoya disease (MMD).MethodsFrom March 2019 to August 2021, 5 patients with hemorrhagic MMD after DC were admitted in Nanfang Hospital. All patients underwent digital subtraction angiography to exclude any spontaneous revascularization between the cortex and temporal muscle and the preservation of STA. Then one-stage treatment with STA-MCA bypass and cranioplasty were performed. If no suitable recipient artery was available, an encephalo-myo-synangiosis procedure was used as a salvage plan.ResultsFour patients underwent direct STA-MCA bypass, while one underwent encephalo-myo-synangiosis due to absence of a suitable recipient artery. All patients had no hemorrhage on postoperative computed tomography, and no new infarcts were detected on magnetic resonance imaging. There were no new recurrent symptoms at clinical follow-up 8 to 24 months after surgery. Three patients had improved Glasgow Outcome Scale scores, and 2 patients had stable Glasgow Outcome Scale scores. Perfusion computed tomography showed improvement in cerebral hemodynamics. Four follow-up digital subtraction angiographies were performed, suggesting graft patency.ConclusionsOne-session treatment with extracranial to intracranial bypass and cranioplasty are safe and effective in patients with MMD who have undergone previous decompressive craniectomy due to hemorrhagic attack.Copyright © 2022 Elsevier Inc. All rights reserved.

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