Treatment in Moyamoya Disease

 

Drug Therapy

There is no drug therapy available for preventing a progression of cerebral ischemia. However, antiplatelet drugs are often administered to reduce the occurrence of stroke.

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Surgical Treatment

Surgical techniques of moyamoya disease are divided into 3 types of revascularization procedures: direct, indirect and a combination of both.

 

Direct revascularization is a procedure anastomosing superficial temporal artery perfusing scalp to middle cerebral artery (STA-MCA bypass).
Indirect revascularization includes EMS (encephalo-myo-synangiosis), EDAS (encephalo-duro-arterio-synangiosis), EMAS (encephalo-myo-arterio-synangiosis), and EDAMS (encephalo-dulo-arterio-myo-synangiosis). These indirect procedures use temporal muscle, inversed dura, or superficial temporal artery placed on the surface of the brain. Approximately 3 to 6 months later, angiogenesis will develop and cerebral blood flow will be improved.

 

Direct revascularization technique is difficult to achieve and it is also more time consuming than indirect procedure. However, compared with indirect revascularization, direct anastomosis improved cerebral blood flow in much shorter time and provided more adequate collateral circulation.
Therefore, ever since we started providing surgical treatment for patients with Moyamoya disease in 1980’s, we have mainly been using the combined revascularization.

 

Direct revascularization