Abstract TP149: Moyamoya Disease in Pregnancy: Protective Effect of Cerebral Revascularization via Pial Synangiosis

Abstract

Introduction: Pregnancy, labor and delivery may lead to hemodynamic changes that could cause neurologic complications in patients with moyamoya disease (MMD). We reviewed an operative series of moyamoya patients treated by pial synangiosis from 1985 to 2012 to identify those patients who became pregnant in an attempt to determine the safety of pregnancy in this group of patients. Methods: Clinical and radiographic records of all adult moyamoya patients treated at a single institution from 1985 to 2012 were retrospectively reviewed. Results: From 1985-2012, 8 pial synangiosis surgeries were performed on 5 women with moyamoya disease before or during pregnancy. The mean age at surgery was 16.2. Four patients presented with stroke and one with transient ischemic attacks. Pre-operative Suzuki grade was III or higher in all treated hemispheres. Post-operative angiogram was available in 3 patients (5 treated hemispheres), and all demonstrated good collateral formation (Matsushima grade A or B). Clinical follow-up was available for an average of 13.0 years (range 1-22.0 years). The mean duration from surgery to delivery was 9.4 years; one patient was diagnosed with MMD during pregnancy and was operated at 4 months gestation. All women experienced successful pregnancy outcome: three had normal vaginal delivery and two underwent Caesarean section. Post-pregnancy stroke occurred on the contralateral hemisphere in one patient originally treated with unilateral moyamoya. This patient was found to have developed MMD on the other hemisphere and underwent additional revascularization. No other complications were observed during the follow-up period. Conclusions: Women with moyamoya disease can go through pregnancy safely and successfully after adequate cerebral revascularization.