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2014 ; 54
(10
): 836-40
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Efficacy of superficial temporal artery-middle cerebral artery double anastomoses
in a patient with rapidly progressive moyamoya disease: case report
#MMPMID24584280
Yokosawa M
; Hayashi T
; Shirane R
; Tominaga T
Neurol Med Chir (Tokyo)
2014[]; 54
(10
): 836-40
PMID24584280
show ga
Moyamoya disease can be associated with a rapidly progressive course in young
patients. This report describes a patient with moyamoya disease who experienced
rapid disease progression, resulting in cerebral infarction and a wide area of
diminished cerebral perfusion. Double superficial temporal artery (STA)-middle
cerebral artery (MCA) anastomoses were utilized to immediately increase cerebral
perfusion in the affected area. This case involved a 5-year-old girl who had been
diagnosed with moyamoya disease and had undergone STA-MCA anastomosis with
indirect bypass in the right hemisphere at the age of 3. At the time of
presentation, magnetic resonance (MR) imaging showed cerebral infarction at the
left frontal lobe, and MR angiography showed rapidly progressive narrowing of the
left MCA that had not been present 3 months prior. N-isopropyl-p-[I123]
iodoamphetamine single-photon emission computed tomography (IMP-SPECT) showed
markedly decreased uptake in the left hemisphere. She underwent emergent STA-MCA
double anastomoses with indirect bypass on the left side. IMP-SPECT showed marked
increase in uptake in the left hemisphere. The anterior cerebral artery (ACA)
territory adjacent to the cerebral infarction also showed increased uptake on the
SPECT. Postoperatively, there were no clinical or radiographic indications of
ischemic or hemorrhagic complications. Double anastomoses are effective in
quickly and significantly increasing blood flow. The postoperative course in this
case was uneventful. Double anastomoses are a surgical option for patients with
moyamoya disease who show rapid disease progression, even in those in the acute
phase of cerebral infarction.