Surgical Results of Multiple Burr Hole Operation in Adult Moyamoya Disease: Preliminary Report

ABSTRACT

OBJECTIVE: The purpose of this study is to clarify good indication and possibility of prevention from ischemic attack and hemorrhage after the multiple burr hole operation. Additionally, progression of occlusion of main vessels and disappearance of moyamoya vessels are analyzed. METHODS: The subjects were eight patients(mean age 49 years, male to female ratio 1 1) of moyamoya disease at our institution who underwent the multiple burr hole operation under local anesthesia between August 1999 and December 2001. Among eight patients, the preoperative angiographic findings according to Suzuki stage were stage II in 4, stage III in 5, and stage IV in 4 hemispheres. In all patients, cerebral blood flow decreased in HMPAO-SPECT. In six patients, the cerebral perfusion reserve was impaired and in two patients, the cerebral perfusion reserve did not increase over 30% in HMPAO-SPECT with acetazolamide by two radiologists. RESULTS: At follow-up angiograms, all patients were found neovascularization but two patients in whom the cerebral perfusion reserve did not increase over 30% were less effective. Disappearance of moyamoya vessels was found in five patients and progression of occlusion of major vessels in two patients. CONCLUSION: Neovascularization and disappearance of moyamoya vessels after the multiple burr hole operation are similar to those of other indirect surgery in adult moyamoya disease. But long-term follow-up studies are needed before conclusions can be drawn on the efficacy of the multiple burr hole operation.