Q: What are the typical symptoms of Moyamoya disease?
A: Transient ischemic attack (TIA) is most frequently seen in Moyamoya disease.
In cases of children, symptoms such as hemiparesis and speech disturbances often develop after the activity that induces hyperventilation (ex. blowing wind instruments, puffing hot meal or crying). Headache is also common among the patients.
A certain proposition of the patients remain asymptomatic throughout their life.
Q: Is Moyamoya disease inherited?
A: Approximately 15% of the patients document family history. Disease related genetic variant was found in recent studies. However, Moyamoya disease is considered to be developed mainly from multifactorial causes.
Q: What treat is needed?
A: Surgical revascularization is effective to reduce the risk of future strokes.
Q: Do I always need surgery when I am diagnosed with Moyamoya disease?
A: Surgery is not necessary when patient’s symptoms are stable. It is also important to assess the status by having multimodal radiological examinations.
Q: I have been diagnosed with Moyamoya disease and was recommended to take aspirin. Does aspirin have any effects on this disease?

Antiplatelet drugs may have some efficacy for preventing subsequent transient ischemic attack (TIA). However, the effect will be less remarkable compared with surgery. In addition, antiplatelet medication does not directly improve cerebral hemodynamics. It should be noted that patients in Asian countries have high prevalence of intracranial hemorrhage, therefore the indiscriminate use of antiplatelet can be harmful in patients in their mid-40’s to 50’s.



Q: Is surgery still effective if my child has cerebral infarction already?
A: There may be a risk of another subsequent stroke which can lead to neurological deficits. Multiple brain lesions can affect intellectual development. We would be able to decide the indication of the surgery based on neuropsychological data as well as the radio graphic study.
Q: I heard that indirect surgery is equally effective. Why does Hokkaido University Hospital perform direct bypass in an adjunct with indirect bypass?
A: Indirect bypass is a simple method that generally requires less amount of operation time. And direct bypass improves cerebral hemodynamics remarkably and rapidly. However, it is often difficult to be accomplished in some children and adults.
We have performed combined direct and indirect bypass simultaneously to maximize the effect of revascularization as well as to minimize the complication rate.
Q: What are the possible complications after the surgery?
A: Approximately 4-5% of the postoperative complications are seen after the surgical procedure. Unfortunately, TIA as well as the stroke have been observed in some patients after the surgery. Delayed wound healing is also seen but the frequency of that has been decreasing in a recent surgical series.
Q: Could you tell me about the length of hospital stay and charges when I undergo surgery for Moyamoya disease?

A charge of surgery is about 1 million yen (approx. US$10,000) and the hospital fee is about 20,000-30,000 yen per day (approx. US$200-$300/day). Extra fee of 8,400 yen (approx. 840 US$/day) will be charged if you wish to stay in a private room. We estimate the in-hospital treatment to be about 2 to 4 weeks for all foreign patients. “Family house” is also available for patient’s family during their stay at the hospital and it costs about 2,000 yen per day (approx. US$20, https://www.huhp.hokudai.ac.jp/english/detail_sp/00001519.html) and we will be able to provide the detail if you decide to stay. We are also teamed up with SAPPORO CLARK HOTEL and you will get the discounted price. (Single room: 4,000 – 5,200 yen / approx. 40 – 52 US$/day) If you wish to stay at this hotel please contact them at htclark@rondo.ocn.ne.jp or visit their website http://www.clark-hotel.co.jp
Other hotels listed below also provide discounted prices for the patients’ family members:


■BUSINESS HOTEL SHINTO: http://www.hotelshinto.jp/
■HOKKAIDO DAI-ICHI HOTEL: http://www.hokkaido-daiichi-hotel.co.jp/
■KITA HOTEL: http://kita-hotel.com/
■HOTEL SUNROUTE SAPPRO: http://www.hotel-sunroute.co.jp/
■ROYTON SAPPORO: http://www.daiwaresort.jp/royton/index.html
■HOTEL PEARL CITY: http://www.hmi-hotel.co.jp/hokkaido/sapporo/
■MARKS INN SAPPORO: http://www.marks-inn.com/sapporo/index.html
■BUSINESS INN NORTE 2: http://www.b-norte.jp/norte2/
■HOTEL Hashimoto: http://www.hotel-hashimoto.com/
■HOTEL DYNASTY: http://www.hotel-dynasty.net/
■HOTEL PACE JR. SUSUKINO: http://www.hotelpaco.com/susukino/


Q: I am a vegetarian. Does the hospital serve vegetarian food?
A: We try our best to serve meals according to the preference of our patients as much as possible. If you have something you cannot eat due to food allergy or a religious dietary restrictions, please do not hesitate to let us know.
Q: Do I have to come back to Japan for a follow-up examination after the surgery?
A: Although we believe it is best for us to see you in person to do a follow-up to confirm your recovery, we also understand that coming back to Japan may be difficult for some patients. In those cases, we would ask you to send us the follow-up MRA and MRI for practical purposes.