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Contralateral progression and its risk factor in surgically treated unilateral adult moyamoya disease with a review of pertinent literature

  • Clinical Article - Vascular
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Abstract

Background

The fate of the contralateral unaffected side of the surgically treated unilateral moyamoya disease (MMD) in adults has not been well described due to the limited number of cases and the heterogeneous ages and treatment methods. The aim of this study was to evaluate the contralateral angiographic progression rate and its risk factors in homogeneous adult MMD patients who underwent surgical revascularization, with a review of pertinent literature.

Methods

Forty-one surgically treated unilateral MMD patients were retrospectively evaluated. We reviewed medical and radiological records including data on gender, age, hypertension (HTN), smoking, familial MMD, presenting symptom, surgical method, Suzuki stage, and contralateral progression. Then, we conducted univariate and multivariate analyses to determine risk factors.

Results

Six of the 41 cases (14.6 %) exhibited contralateral progression during the mean follow-up of 34 months. Four of those six patients (66.7 %) were asymptomatic. Additional revascularization surgery was performed in the two symptomatic patients. The presence of a contralateral angiographic abnormality on initial angiography was a statistically significant risk factor for progression (OR, 49.00; p = 0.04). Younger age at diagnosis (32.7 ± 7.8 years in progression group vs. 42.5 ± 10.3 years in non-progression group, p = 0.046) was statistically significant in the univariate analysis, but age was not a significant factor in the multivariate analysis (p = 0.82). Other variables, such as gender (p = 0.13), HTN (p = 0.24), smoking (p = 0.47), and familial MMD (p = 0.20), did not show statistical significance.

Conclusions

The presence of a contralateral angiographic abnormality on initial angiography was a significant risk factor for progression in surgically treated unilateral adult MMD. Consequently, patients with contralateral abnormalities should be monitored closely.

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Acknowledgments

We would like to thank Sung-Eun Kim for help with data collection and for valuable contributions to the statistical analysis.

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None to disclose.

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Authors and Affiliations

  1. Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea

    Sang Chul Lee, Jin Sue Jeon, Jeong Eun Kim, Young Seob Chung, Jun Hyong Ahn, Won-Sang Cho, Young-Je Son, Jae Seung Bang, Hyun-Seung Kang & Chang Wan Oh

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  1. Sang Chul Lee
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  2. Jin Sue Jeon
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  3. Jeong Eun Kim
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  7. Young-Je Son
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Corresponding author

Correspondence to Jeong Eun Kim.

Additional information

Sang Chul Lee and Young Seob Chung contributed equally to this work.

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Lee, S.C., Jeon, J.S., Kim, J.E. et al. Contralateral progression and its risk factor in surgically treated unilateral adult moyamoya disease with a review of pertinent literature. Acta Neurochir 156, 103–111 (2014). https://doi.org/10.1007/s00701-013-1921-8

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  • DOI: https://doi.org/10.1007/s00701-013-1921-8

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