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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2014; 01(02): 131-136
DOI: 10.4103/2348-0548.130399
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Anaesthetic management of patients undergoing surgery for Moyamoya disease – our institutional experience

Vivek B. Sharma
1   Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India
,
Hemanshu Prabhakar
1   Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India
,
Girija Prasad Rath
1   Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India
,
Parmod K. Bithal
1   Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations
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Publication Date:
28 April 2018 (online)

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Abstract

Background: Moyamoya disease (MMD) is a chronic cerebrovascular disorder, defined as the progressive stenosis or occlusion of the intracranial vessels. Because of the insecure cerebral circulation, these patients represent an anaesthetic challenge. Literature is scarce on the anaesthetic management of MMD, especially from the Indian subcontinent. The main objective of our study was to evaluate the peri-operative course and outcome of patients undergoing surgery for MMD. Materials and Methods: We analysed available medical records of all patients who underwent revascularisation surgeries for MMD over a period of 10 years (January 2002 to June 2012). Various intra- and post-operative data related to anaesthesia were recorded. The patients for the analysis were divided into two groups: Group 1, paediatrics (<18 years) and group 2, adults (≥18 years). Data are presented as number (%) or mean ± SD or median (range). Results: There were 36 patients (12 adults and 24 children). Normotension, normovolaemia, normo- or mild-hypercapnia and normothermia were maintained in all patients. No patient developed complications or new neurological deficit in the post-operative period. All patients were discharged with a full Glasgow coma scale (GCS) and no new neurologic deficit. Conclusion: Although the incidence of MMD is not high in India, it is an important cause of cerebral stroke in children and adults. Proper pre-operative evaluation is the most effective method to achieve good results. Anaesthetic management of MMD should focus on the maintenance of adequate cerebral blood flow and cerebral perfusion pressure ensuring adequate cerebral oxygenation to avoid ischaemic complications.

Keywords

Anaesthesia - moyamoya disease - risk factors - surgery
 

  • REFERENCES

  • 1 Takeuchi K, Shimizu K. Hypo genesis of bilateral internal carotid arteries. No To Shinkei 1957; 9: 37-43
    PubMedSearch in Google Scholar
  • 2 Suzuki J, Takaka A. Cerebrovascular “moyamoya” disease: Diseases showing abnormal net-like vessels in base of brain. Arch Neurol 1969; 20: 288-99
    CrossrefPubMedSearch in Google Scholar
  • 3 Fukuyama Y, Kanai N, Osawa M. Clinical genetic analysis on the moyamoya disease. The research committee on spontaneous occlusion of the circle of willis (moyamoya disease) of the ministry of health and welfare Japan: Annual Report 1992. Tokyo, Japan: Ministry of Health and Welfare Japan; 1992: 141-6
    Search in Google Scholar
  • 4 Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med 2009; 360: 1226-37
    CrossrefPubMedSearch in Google Scholar
  • 5 Parray T, Martin TW, Siddiqui S. Moyamoya Disease: A review of the disease and anesthetic management. J Neurosurg Anesthesiol 2011; 23: 100-9
    CrossrefPubMedSearch in Google Scholar
  • 6 Fung L, Thompson D, Ganesan V. Revascularisation surgery for peadiatric moyamoya: A review of the literature. Childs Nerv Syst 2005; 21: 358-64
    CrossrefPubMedSearch in Google Scholar
  • 7 Kuriyama S, Kusaka Y, Fujimura M, Wakai K, Tamakoshi A, Hashimoto S. et al. Prevalence and clinicoepidemiological features of moyamoya disease in Japan: Findings from a nationwide epidemiological survey. Stroke 2008; 39: 42-7
    CrossrefPubMedSearch in Google Scholar
  • 8 Miao W, Zhao PL, Zhang YS, Liu HY, Chang Y, Ma J. et al. Epidemiological and clinical features of Moyamoya disease in Nanjing, China. Clin Neurol Neurosurg 2010; 112: 199-203
    CrossrefPubMedSearch in Google Scholar
  • 9 Ikezaki K, Han DH, Kawano T, Kinukawa N, Fukui M. A clinical comparison of definite moyamoya diseases between South Korea and Japan. Stroke 1997; 28: 2513-7
    CrossrefPubMedSearch in Google Scholar
  • 10 Lee SH, Heros RC, Mullan JC, Korosue K. Optimum degree of hemodilution for brain protection in a canine model of focal cerebral ischemia. J Neurosurg 1994; 80: 469-75
    CrossrefPubMedSearch in Google Scholar
  • 11 Kansha M, Irita K, Takahashi S, Matsushima T. Anesthetic management of children with moyamoya disease. Clin Neurol Neurosurg 1997; 99: S110-3
    CrossrefPubMedSearch in Google Scholar
  • 12 Nomura S, Kashiwagi S, Uetsuka S, Uchida T, Kubota H, Ito H. Perioperative management protocols for children with moyamoya disease. Childs Nerv Syst 2001; 17: 270-4
    CrossrefPubMedSearch in Google Scholar
  • 13 Matsushima Y, Aoyagi M, Suzuki R, Tabata H, Ohno K. Perioperative complications of encephalo-duro-arterio-synangiosis: Prevention and treatment. Surg Neurol 1991; 36: 343-53
    CrossrefPubMedSearch in Google Scholar
  • 14 Soriano SG, Sethna NF, Scott RM. Anesthetic management of children with moyamoya syndrome. Anesth Analg 1993; 77: 1066-70
    PubMedSearch in Google Scholar
  • 15 Singh D, Rath GP, Dash HH, Bithal PK. Sevoflurane provides better recovery as compared with isoflurane in children undergoing spinal surgery. J Neurosurg Anesthesiol 2009; 21: 202-6
    CrossrefPubMedSearch in Google Scholar
  • 16 Sakamoto T, Kawaguchi M, Kurehara K, Kitaguchi K, Furaya H, Karasawa J. Risk factors for neurologic deterioration after revascularization surgery in patients with moyamoya disease. Anesth Analg 1997; 85: 1060-5
    CrossrefPubMedSearch in Google Scholar
  • 17 Sato K, Shirane R, Kato M, Takashi Y. Effect of inhalational anesthesia on cerebral circulation in Moyamoya disease. J Neurosurg Anesthesiol 1999; 11: 25-30
    CrossrefPubMedSearch in Google Scholar
  • 18 Adachi K, Yamamoto Y, Kameyama E, Suzuki H, Horinouchi T. Early postoperative complications in patients with Moyamoya disease: A comparison of inhaled anesthesia with total intravenous anesthesia (TIVA). Masui 2005; 54: 653-7
    PubMedSearch in Google Scholar
  • 19 Kurehara K, Ohnishi H, Touho H, Furuya H, Okuda T. Cortical blood flow response to hypercapnia during anaesthesia in Moyamoya disease. Can J Anaesth 1993; 40: 709-13
    CrossrefPubMedSearch in Google Scholar
  • 20 Nishimoto A, Onbe H, Ueta K. Clinical and cerebral blood flow study in Moyamoya disease. Acta Neurol Scand 1983; 60: 360-8
    PubMedSearch in Google Scholar
  • 21 Kuwabara Y, Ichiya Y, Sasaki M, Yoshida T, Masuda K, Matsushima T. et al. Response to hypercapnia in moyamoya disease. Cerebrovascular response to hypercapnia in pediatric and adult patients with moyamoya disease. Stroke 1997; 28: 701-7
    CrossrefPubMedSearch in Google Scholar
  • 22 Sato K, Shirane R, Yoshimoto T. Perioperative factors related to the development of ischemic complications in patients with moyamoya disease. Childs Nerv Syst 1997; 13: 68-72
    CrossrefPubMedSearch in Google Scholar
  • 23 Iwama T, Hashimoto N, Yonekawa Y. The relevance of hemodynamic factors to perioperative ischemic complications in childhood moyamoya disease. Neurosurgery 1996; 38: 1120-5
    PubMedSearch in Google Scholar
  • 24 Kurokawa T, Chen YJ, Tomita S, Kishikawa T, Kitamura K. Cerebrovascular occlusive disease with and without the moyomoya vascular network in children. Neuropediatrics 1985; 16: 29-32
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Ahn HJ, Kim JA, Lee JT, Kim HS, Shin HJ, Chung IS. et al. Effect of preoperative skull block on pediatric moyamoya disease. J Neurosurg Pediatr 2008; 2: 37-41
    CrossrefPubMedSearch in Google Scholar