Abstract TMP42: Treatment of Moyamoya Disease in the Adult Population with Pial Synangiosis

Abstract

Introduction: Surgical treatment of moyamoya disease in the adult population commonly employs direct revascularization, the superficial temporal artery to middle cerebral artery (STA-MCA) bypass. Pial synangiosis, a method of indirect revascularization, has been utilized in adult moyamoya patients when STA-MCA bypass is not technically feasible. Although the effectiveness of pial synangiosis has been well described in children, only limited reports have examined its role in adult moyamoya patients. Here we report on our experience with pial synangiosis revascularization for this population. Methods: We reviewed the clinical and radiographic records of all adult moyamoya patients (18 years of age or older), who underwent cerebral revascularization surgery using pial synangiosis at a single institution. Results: From 1985-2010, 66 procedures (6 unilateral, 30 bilateral) were performed on 36 adult moyamoya patients. The mean age at surgery was 28.3 (range: 19 - 51) and 30 were female. Thirty-one patients (86.1%) presented with either stroke or TIA and 3 (8.3%) with hemorrhage. Pre-operative Suzuki grade was III or higher in 50 hemispheres (75.7%) and 3 patients had prior treatments to the affected hemisphere before pial synangiosis surgery. Clinical follow-up was available for an average of 5.8 years (range 0.6-14.1 years), with 26 (72.2%) patients followed for longer than 2 years. Post-operative angiogram was available for 24 patients and 46 revascularized hemispheres, and 39 (84.8%) demonstrated good collateral formation (Matsushima grade A or B). Peri-operative complications included 3 strokes, 5 TIA’s, and 2 seizures, and there was no stroke or hemorrhage during the follow-up period. One patient required additional revascularization surgery 8 months after pial synangiosis. Conclusions: Pial synangiosis is a safe, effective, and durable method of cerebral revascularization in adult moyamoya patients. Our data supports the utilization of pial synangiosis as a treatment option for moyamoya disease in adults, particularly when STA-MCA bypass is not technically feasible.